Study of the Relative Frequency of Spontaneous Pneumothorax Recurrence with Two Policy Therapies: A Clinical Trial.

Background: Spontaneous pneumothorax is a potentially fatal condition with a high risk of recurrence. The purpose of this study is to compare two different approaches to SP management. In the first group, patients underwent only chemical pleurodesis; in the second group, CT-scan, VATS, and then chemical pleurodesis was performed. Materials and Methods: This study is a non-randomized clinical trial conducted on 65 patients admitted to Al-Zahra Hospital in Isfahan with a primary complaint of sudden dyspnea and a definitive diagnosis of spontaneous pneumothorax. Two studies compared the main outcomes of recurrence within six months and the time until recurrence. Results: Age, sex, and BMI were matched between the two study groups. The side of the pneumothorax, smoking history, and pulmonary disease history did not differ significantly (P > 0.05). Pneumothorax recurrence did not differ significantly between the two groups (P: 0.477). Conclusion: This study demonstrated no distinction between VATS and chemical pleurodesis when using only chemical pleurodesis. However, because numerous studies have suggested that one of these techniques may be beneficial for patients with SP, it is recommended to conduct additional randomized controlled trials (RCTs) with a more detailed plan and more comparable procedures, although it appears that meta-analysis design may be effective given the abundance of available RCT studies.

GLIS2 and CCND1 expression levels in breast cancer patients.

BACKGROUND: Breast cancer (BC) is the most prevalent cancer in women, with increasing incidence and death rates in recent years. Disruptions of different signaling pathways partially cause breast cancer. Hence, different genes through particular pathways are involved in BC tumorigenesis. METHODS: In this study, we evaluated the expression level of GLIS2 and CCND1 genes in 50 patients. Also, in-silico analyses were used to enrich related signaling pathways involving the mentioned genes. RESULTS: The results showed an increased expression level of Cyclin D1 and decreased expression level of GLIS2 in BC patients. Moreover, a relationship between aberrant expression levels of GLIS2 and CCND1 and BC development was determined. CONCLUSION: These observations could help uncover new therapeutic targets for treating patients with BC in the progressive stage.

Micrometastasis in colorectal cancer: does it affect staging?

BACKGROUND: Micrometastasis (MM) in colorectal cancer (CRC) is not considered in tumour-node-metastasis (TNM) staging currently and also the prognostic significance of these occult tumoural cells is not proven yet. This study was designed to find whether MM to bone marrow (BM) and/or liver cause upstaging of the tumour according to conventional staging system and if it may alter the survival rate. METHODS: Thirty-eight CRC patients who were candidates of surgical procedure were enrolled in our cross-sectional study. Liver and BM biopsy were obtained during the surgery to be looked for tissue-specific marker of CRC, CK20. CK20 expression in BM and liver was assessed by the two methods of reverse transcriptase polymerase chain reaction and immunohistochemistry. RESULTS: Among the 38 submitted patients, a total number of 14 MM, including 10 BM (23%) and seven hepatic (18%) were detected. There was no significant difference in clinicopathological aspects including size, location, stage, grade, local invasion to vessels and neurons, TNM staging and relapse rate of tumour among patients with/without disseminated tumoural cells. The result did not demonstrate a survival difference between patients receiving neoadjuvant chemotherapy compared to other patients. CONCLUSION: Our study did not confirm that the presence of MM influences TNM staging and overall survival of the patients. Additional clinical investigations with longer follow-up period and larger number of cases are required to decide on administration of neoadjuvant therapy in CRC patients.

Comparison of pyloromyotomy, pyloric buginage, and intact pylorus on gastric drainage in gastric pull-up surgery after esophagectomy.

BACKGROUND: There are controversies regarding the usefulness of the pyloric drainage methods after esophagectomy as well as differences among various pyloric drainage techniques. Therefore, we compared the outcome of pyloromyotomy, pylorus buginage, and no intervention methods on gastric emptying among patients undergone esophagectomy. MATERIALS AND METHODS: In this randomized clinical trial, patients with diagnosed esophageal cancer or any other benign lesions candidate for esophagectomy were selected. They randomized in three groups with three different approaches for gastric pull-up esophageal surgery including esophagectomy with pyloromyotomy, esophagectomy without intervention, and esophagectomy with pylorus buginage. The outcomes of procedures regarding gastric emptying time and delayed gastric emptying were compared. RESULTS: Thirty patients were allocated in three groups. Gastric emptying time was not significantly different in the three groups (P > 0.05). Frequency of delayed gastric emptying, complications and barium leakage were not different in three studied groups (P > 0.05). CONCLUSION: Gastric emptying time and delayed gastric emptying were not different between common pyloric drainage methods after esophagectomy and esophagectomy without drainage.

A case of the long time presence of a large foreign body in esophagus without complication.

Dentures are common accidentally ingested foreign bodies (FBs), especially in the aged population. It is usual for a FB to be swallowed in adults and lodge in the esophagus; however, it is unusual for a denture to remain in esophagus for a period of 9 months without any complication. We present, a 57-year-old deaf mute man swallowed his denture with the chief complaint of dysphagia and odynophagia only after 9 months. Although multiple attempts for removing the denture by rigid esophagoscopy were done, it entered the stomach, so gastrotomy was performed and the patient recovered uneventfully. In all cases with suspicion of esophageal FB, rigid esophagoscopy seems necessary, but in some unusual cases, large FBs may be remained in esophagus for a long time without perforation.

Effects of Topical Kiwifruit on Healing of Chronic Bedsore.

Kiwifruit (Actindia deliciosa) is demonstrated to have antibacterial and pro-angiogenic effect. Moreover, this fruit contains proteolytic enzymes (actinidin) and ascorbic acid. Considering these properties and based on the results of recent animal studies, we carried out this study to evaluate the effects of kiwifruit on bedsore in clinical settings. Forty patients with stage 2-3 sacral bedsores, preferably paraplegic, quadriplegic, and/or hemiplegic, were allocated into two groups of experiment and control. Under local anesthesia and sedation, ulcers of the experiment and control groups were dressed with pure extract of kiwifruit and normal saline, respectively, on a daily basis for 21 days. The ulcers were examined and photographed weekly. Pre- and postintervention biopsies were taken from the ulcers to perform microbiological and histological study. Mean reduction in surface area of bedsore in the experiment group was significantly higher than the control group (486.47 vs. 117.38 mm, p < 0.001). The amount of collagen and granulation tissue were significantly higher in experiment groups than the control group (p value 0.005 and 0.02, respectively). Significantly higher levels of angiogenesis and vascularization were found in the kiwifruit-treated patients (p < 0.02). In addition, obvious antibacterial effect was observed in the kiwifruit group. Natural compounds in the kiwifruit, including protein-dissolving enzymes (actinidin) and antibacterial agents, improve different aspects of the wound healing process. Based on its benefits and safety, we conclude that using kiwifruit is a simple, applicable, and effective way for treatment of bedsore.

Effects of topical Kiwifruit on healing of neuropathic diabetic foot ulcer.

BACKGROUND: Kiwifruit (Actindia Deliciosa) is demonstrated to have antibacterial and pro-angiogenic effects. It also contains proteolytic enzymes (actinidin) and ascorbic acid. In this study, the effects of Kiwifruit on neuropathic diabetic foot ulcer healing in clinical settings were evaluated. MATERIALS AND METHODS: In this randomized clinical trial of 37 patients (17 in experimental and 20 in control groups) with neuropathic diabetic foot ulcer were studied in Isfahan-Iran. Patients of the control group received just the standard treatments. In the experimental group, in addition to the standard treatments, ulcers were dressed with pure extract of kiwifruit twice daily for 21 days. The ulcers were examined and evaluated based on macroscopic, microscopic and microbiological status. Pre- and post-interventions, biopsies were taken from the ulcers to perform microbiological and histological studies. RESULTS: Mean reduction in surface area of foot ulcer in the experimental group was significantly higher than the control group (168.11 ± 22.31 vs. 88.80 ± 12.04 mm(2) respectively, P < 0.0001). The amount of collagen and granulation tissues was significantly higher in the experimental groups than the control group (P value < 0.0001). Significantly higher levels of angiogenesis and vascularization were found in the kiwifruit treated patients (P value < 0.0001). No significant antibacterial effect was observed for kiwifruit. CONCLUSION: Natural compounds in the kiwifruit including protein-dissolving enzymes (Actinidin) improved different aspects of the wound healing process. Based on these benefits and safety aspects, we conclude that using kiwifruit is a simple, applicable and effective way for treatment of neuropathic diabetic foot ulcer.

The significance of clinicopathological aspects of tumor for the detection of liver micrometastasis in patients with colorectal cancer.

BACKGROUND: Colorectal tumor is one of the main causes of death in our country. The aim of the present study was to determine the clinicopathological aspects of tumor and the presence of hepatic micrometastasis in patients with colorectal cancer (CRC). MATERIALS AND METHODS: Forty two patients with CRC were evaluated in the study surgical treatment was performed and liver biopsy was taken for the evaluation of micrometastasis by immunohistochemistry and polymerase chain reaction. The variables that have been evaluated were: Patient's gender, patients age at the time of diagnosis, size and location of tumor, tumor-node-metastasis stage and grade of the primary tumor, lymph node involvement, lymphovascular and neural invasion, presence of macrometastasis and carcinoembryonic antigen level prior to surgery. After 1 year patients were called and asked to come back to the clinic for elective colonoscopy to evaluate the surgical site for recurrence of tumor and survival. All variables were compared between patients in whom liver micrometastasis were present in comparison with patients without liver micrometastasis. RESULTS: Of the studied patients (6 with positive micrometatsis and 36 without micrometstasis), 38 were alive after 1 year (6 with positive micrometatsis and 32 without micrometstasis) and the difference was not significant between groups with or without micrometastasis (P = 0.52). In four of survived patients colonoscopy was abnormal, however this difference was not also significant between groups (P = 0.59). CONCLUSION: Clinicopathologic aspect of tumor was not different in CRC patients with and without hepatic micrometastasis.

Bronchial stump closure with amniotic membrane in animal model.

BACKGROUND: Coverage of the bronchial stumps (BSs) with adjacent tissues can improve healing and reduce bronchial complications in complex thoracic surgery. There is no evidence for the application of human amnion allograft for prevention of air leak from the BS. The comparison of the amniotic membrane (AM) and pleural patch for BS healing after lobectomy in dogs was our aim in this study. MATERIALS AND METHODS: A total of eight males and females 12-24-month-old dogs between 17 and 22 kg body-weight were used in this study in 2010, Isfahan University of Medical Sciences. Animals were separated into two groups: group A (n = 4; amniotic membrane) and group P (n = 4; pleural patch) according to the BS closure technique performed. After lobectomy of the right middle lobe, the BS was closed, while a small bronchopleural fistula (BPF) was created by inserting a catheter via edges of closed stump. Then, it was covered with a piece of AM3 × 3 cm in group A and with a pedicle graft of pleura in group P. Rethoracotomy was performed after 15 days of observation, and the BS was removed for histological examination. Histological healing was classified as complete or incomplete healing. Neoangiogenesis was measured by Von Willebrand expression using immunohistochemistry (IHC). Data were analyzed by SPSS version 15 using Fisher's exact test, Mann-Whitney test, and T tests. RESULTS: BPF complications were not seen during observation period. There was no significant difference in histological healing between two groups. Similarly, no significant difference was observed between the groups in terms of neoangiogenesis based on IHC examination (P value = 0.69). CONCLUSION: Human amnion allograft could be as effective as pleural patch for BS wrapping following pulmonary resections.

Azygos vein aneurysm as a posterior mediastinal mass discovered after minor chest trauma.

Azygos vein aneurysm is a rare cause of a posterior or paratracheal mediastinal mass. Trauma or conditions causing elevated flow or pressure in the azygos system, such as cardiac failure or cirrhosis of the liver are secondary causes of aneurysm of the azygos vein. We report a case of asymptomatic saccular aneurysm of the azygos vein in a 45-year-old man with blunt minor chest trauma. The azygos vein aneurysm was managed by conservative treatment.

A rare case of laryngotracheal chondrosarcoma in a patient with past history of radioiodine therapy for thyroid cancer.

Tracheal chondrosarcoma is a rare malignant mesenchymal tumor and there are less than 15 reports in the literature. We report a rare case of laryngotracheal chondrosarcoma in a 74-year-old man. He gave a history of radioiodine therapy for thyroid papillary carcinoma about 24 years ago. Diagnostic steps, histological presentation, and therapy are described in detail.

Successful auto-implantation of hepatic cells in lung tissue: An animal study.

BACKGROUND: This study was proposed to evaluate a new method for autograft transplantation of liver tissue fragments (LTF) in the lung parenchyma and bronchus of dogs and to compare the results to find out if they are suitable sites for hepatocyte implantation or not. MATERIALS AND METHODS: THE DOGS WERE RANDOMLY ASSIGNED INTO TWO CATEGORIES: LTF auto-transplantation to the lung parenchyma and into the bronchus. The suspensions of normal saline and LTF were injected and implanted into the lung parenchyma and the main bronchus of the right accessory lobe in first and second groups, respectively. Two weeks later the right accessory lobe was removed and sent for a histopathological study. All samples were checked under a light microscope with regard to the presence of hepatocytes, with both the Hematoxylin and Eosin (H and E) preparation and immunohistochemistry (IHC) method, using a CK-18 marker. All results were double-checked with a polymerase chain reaction (PCR). RESULTS: The mean weight of all the dogs was 19.87 ± 0.93 kg and mean age was 3.58 ± 0.31 years. After 15 days, the H and E, IHC, and PCR studies revealed that in the first group, all the dogs (n = 4) had living liver tissue, which survived in the lung parenchyma successfully. In contrast, none of the dogs (n = 0) in the second group showed surviving hepatocytes in the bronchus (P < 0.001). CONCLUSION: Implantation of the LTFs into the lung parenchyma could be a source of hepatic cell production.

Cell cycle analysis of the CD133(+) and CD133(-) cells isolated from human colorectal cancer.

AIM: The CD133 antigen has been identified as a putative stem cell marker in colorectal cancer tissues. The aim of this study was to investigate the cell cycle state of CD133(+) and CD133(-) cells, isolated from primary human colorectal tumors. MATERIALS AND METHODS: After mechanical and enzymatic dissociation of the tumor samples, CD133(+) and CD133(-) subsets were identified and separated by magnetic cell sorting. Flow cytometric analysis was performed to compare the cell cycle of both CD133(+) and CD133(-) cells isolated from primary and liver metastatic cancer cells. RESULTS: The results indicated that CD133(+) cells isolated from both primary and liver metastatic colorectal cancers were found in higher percentage in the G0/G1 phases. However, the CD133(-) cells isolated from primary colorectal cancers were predominantly found in the S and G2/M phases. Surprisingly, the CD133(-) cells isolated from liver metastatic colorectal cancers were mostly found in the G0/G1 phase. CONCLUSION: The present study provides evidence that CD133(+) cells are in a quiescent state in colorectal cancer, representing a mechanism that would at least partially explain chemotherapy resistance and tumor recurrence in post-therapy patients.

Micrometastasis in non-small-cell lung cancer: Detection and staging.

BACKGROUND: The clinical relevance of bone marrow micrometastasis (BMM) in non-small-cell lung cancer is undetermined, and the value of such analyses in advanced stage patients has not been clearly assessed previously. This study was conducted to estimate the accuracy of both polymerase chain reaction (PCR) and immunohistochemistry (IHC) in micrometastases detection and determine the best site for bone marrow biopsy in order to find micrometastasis. METHODS: This prospective cross-sectional study was performed in the Department of Thoracic Surgery, Alzahra University Hospital from September 2008 to June 2009. To evaluate the bone marrow, a 3-cm rib segment and an aspirated specimen from the iliac bone prior to tumor resection were taken. PCR and IHC were performed for each specimen to find micrometastasis. RESULTS: Of 41 patients, 14 (34%) were positive for BMM by PCR compared with two positive IHC (4.8%). All BMMs were diagnosed in rib segments, and iliac specimens were all free from metastatic lesion. Our data showed no significant association between variables such as age, sex, histology, tumor location, side of tumor, involved lobe, smoking, or weight loss and presence of BMM. CONCLUSION: PCR could use as a promising method for BMM detection. BMM in a sanctuary site (rib) is not associated with advanced stages of lung cancer. In addition, when predictor variables such as age, sex, histology, tumor location, smoking, or weight loss are analyzed, no correlation can be found between micrometastasis prevalence and any of those variables.

The effect of dressing with fresh kiwifruit on burn wound healing.

BACKGROUND: This study was designed to evaluate the wound healing effects of kiwifruit in the treatment of second-degree burn wounds in rats. METHODS: Sixty rats were each randomly assigned to 1 of 3 groups. A deep second-degree burn was created on the lateral flank of each rat with a standard burning procedure in the form of applying a heated plaque. In the control group (group C; n = 20) burns were dressed with Vaseline sterile gauze after normal saline irrigation. In group S (n = 20), the lesions were treated with silver sulfadiazine cream after normal saline irrigation. In the third group (group K; n = 20), the burn wounds were dressed with kiwifruit. The dressings were changed twice a day in all groups. The response to treatments was assessed histologically at day 21 postburn and microbiologically on days 7 and 21. Macroscopic evaluation was performed every day to determine wound closure rate, measure burn wound area, and investigate macroscopic edema, hyperemia, and epithelialization. Histopathologic evaluation included monitoring of epithelialization, vascularization, granulation tissue formation, and inflammatory cell response. RESULTS: On day 21, the wounds in the group K healed completely in comparison to other groups (P < .0001). There was significant reduction in wound area size in the group K in all evaluation days as compared with groups S and C (P < .0001). Microscopic evaluation revealed a high grade of neovascularization in group K lesions in contrast with groups S and C (P < .0001). Wound infection was dramatically less common in the group K compared with the other 2 groups (P < .05). CONCLUSION: We suggest that the dramatic antibacterial, debridement, wound contracture, and angiogenic effect of kiwifruit induced a significant wound healing in burn ulcers and might be useful in treating chronic ulcers, such as bedsores.

Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy.

OBJECTIVE: The objective of our study was to identify the incidence and risk factors of anastomotic leaks following transhiatal esophagectomy (THE). MATERIALS AND METHODS: A prospective study was conducted on 61 patients treated for carcinoma of the esophagus between 2006 and 2007. We examined the following variables: age, gender, preoperative cardiovascular function, intraoperative complications such as hypotension, arrhythmia, mediastinal manipulation period, blood loss volume, blood transfusion, duration of surgery, postoperative complications such as anastomotic leak, anastomotic stricture, requiring reoperation, respiratory complications, and total morbidity and mortality. Variables were compared between the patients with and without anastomotic leak. T-test for quantitative variables and Chi-square test for qualitative variables were used to find out any relationship. P value less than 0.05 was considered significant. RESULTS: Out of 61 patients, anastomotic leaks occurred in 13 (21.3%). Weight loss, forced expiratory volume (FEV1) < 2 lit, preoperative albumin, intaoperative blood loss volume, and respiratory complication were associated with the anastomotic leak in patients undergoing THE. Anastomotic leaks were the leading cause of postoperative morbidity, anastomotic stricture, and reoperation. CONCLUSION: Anastomotic leakage is a life-threatening postoperative complication. Careful attention to the factors contributing to the development of a leak can reduce the incidence of anastomotic complications postoperatively.