The Role of Intraoperative Thyroglobuline Level of Lymph Node in the Management of Papillary Thyroid Cancer (Determination of a Cutoff Point).

BACKGROUND: Some studies have shown that a preoperative high concentration of thyroglobulin (Tg) in wash out of fine-needle aspiration cytology of cervical lymph nodes mandate therapeutic lymph node dissection. However, there is disagreement about the minimum concentration of Tg which could have diagnostic value. Hence, according to our literature review, this study is the first one which designed to do intraoperatively. Therefore, this study was conducted and aimed to determine the clinical diagnostic value of Tg lymph nodes in the diagnosis of metastatic thyroid cancer. METHODS: In a cross-sectional study, 65 patients with papillary thyroid carcinoma (PTC) who were thyroidectomy candidates were chosen and during surgery, before the removal of lymph nodes in the neck, fine-needle sampling was performed and the level of Tg in the samples, nature of the sample sent for biopsy and Tg levels in affected and unaffected lymph nodes were determined. RESULTS: The mean levels of washout Tg in malignant and nonmalignant lymph nodes were 622.1 ± 66.2 and 1.38 ± 0.43 ng/ml, respectively, and the difference between the two groups was significant (P < 0.001). The Tg cut-off point for the detection of lymph node metastases was 0.7 ng/dl, and according to it, Tg washout sensitivity was 93.8%, specificity of 92.4%, false positives 7.76%, false negatives 6.3%, positive predictive value was 92.3%, and negative predictive value was 93.8% and accuracy was 93.1%. CONCLUSION: Based on the results, Tg level of cervical lymph nodes in patients with PTC is a suitable criterion for the diagnosis of lymph node which can be determined through fine-needle biopsy. Therefore, it is suggested that in patients with suspicion of lymph nodes involvement during surgery, fine-needle biopsy and determination of the Tg level performed.

Pulmonary function tests in patients with amyotrophic lateral sclerosis and the association between these tests and survival.

BACKGROUND: The rapidity of progression of amyotrophic lateral sclerosis (ALS) to death or respiratory failure impacts patients, clinicians, and clinical investigators. The aim of this study is to evaluate of the pulmonary function tests (PFTs) in patients with ALS and the association between these PFTs and survival Methods: A total of 36 ALS patients who PFTs, including vital capacity (VC), maximum mid-expiratory flow rate (MMEFR), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), were available from the time of diagnosis were included in this study. Non-pulmonary characteristics assessed at the time of PFTs. Data were analyzed using chi-square, Student's independent t-test, Kaplan-Meier, correlation, and receiver operating characteristic (ROC) curve. RESULTS: The mean age of subjects was 55.36 (SD = 12.24) year, and the male to female ratio was 2.6. Twenty-five (69.4%) were died in 5 years period of our study. The mean and median survival time (In months) was calculated as 42.51 (95% confidence interval [CI] 33.64-51.39) and 38 (95% CI 27.23-48.77) months, respectively. The rate of ALS survival was 74% at 1(st) year, 41% at 3(rd) year and 10% at 5(th) year of starting symptoms. The results of Kaplan-Meier test showed survival was significantly longer in the group with PFTs closer to normal. In addition, ROC analysis showed that FVC < 50% could potentially be a predictor of death in ALS patients(P = 0.003, area under curve = 0.649). CONCLUSION: We found single measures of upright FVC, FEV1 to be significantly associated with survival, even after controlling for relevant non-pulmonary patient characteristics. Our study demonstrated that upright FVC, FEV1, VC, and MMEFR are useful non-invasive measures in the prediction of survival in ALS.

Effect of Zafirlukast on improving lung function in patients with chronic obstructive pulmonary diseases.

BACKGROUND: There is little evidence about the role of Zafirlukast (a highly selective LTD4 antagonist) in Chronic Obstructive Pulmonary Disease (COPD). The Zafirlukast can reduce the need for short-acting rescue ß2 agonists, produce fewer exacerbations of asthma and increased quality of life as possible benefits treatment for asthma. The aim of our study was to evaluate the effects of Zafirlukast improvement of lung function in patients with COPD. METHODS: Twenty five patients with moderate to severe COPD, in stable phase of the disease, participated in this interventional, quasi-experimental study. All patients were received 40mg oral Zafirlukast per day for 2 weeks. Pulmonary function Test was performed both at the baseline and at the end of the study. Data were analyzed with paired t-test using SPSS v.16. RESULTS: The mean age of the patients was 67.29 (SD=5.56) years with the mean baseline for forced expiratory volume in first second (FEV1) equal to 41.79% (SD=14.96) of predicted value. After 2 weeks, the mean improvements in forced vital capacity (FVC), FEV1 and FEV1/FVC were 4.75% (SD=13.18), 3.71% (SD=9.19) and 9.33(SD=27.08), respectively. Zafirlukast produced a non-significant (p>0.05) bronchodilation, with maximum mean increase in FEV1 of 0.04 lit (3%) above baseline. CONCLUSION: Results showed that Zafirlukast has no considerable bronchodilatory effect in COPD. Present study consisted of a very short treatment period and it is possible that the extension of this period could possibly have more effects. Additional larger studies are needed to verify the impact of leukoterien receptor antagonists on improving the lung function in COPD patients.

Comparison of the serum concentration of zinc in patients with bronchiectasis and control group.

BACKGROUND: Bronchiectasis is an abnormal and permanent dilatation of bronchi. Infection plays a major role in causing and perpetuating bronchiectasis, as reducing the microbial load and attendant mediators are cornerstone of therapy. Zinc, as an integral micronutrient is involved in the immune reactions including response to infection. In several previous studies, mild zinc deficiency has been described in many infectious diseases such as abscess, cellulitis, chronic diarrhea, pneumonia, tuberculosis (TB), etc. OBJECTIVES: The purpose of this study was to determine serum zinc level in a series of patients suffering from bronchiectasis and to compare it with healthy control group. PATIENTS AND MATERIALS: This analytical cross-sectional study was performed on thirty four patients with proven bronchiectasis and twenty nine healthy control subjects referred to Rasoul-e-Akram Hospital, Tehran, Iran, between March 2005 and March 2007. Serum concentration of the zinc was measured for all of the subjects and other information was completed according to their medical records. Both groups (case and control) were frequently matched regarding their age groups. RESULTS: Patients included 11 (32.4%) males and 23 (67.6%) females with the average age of 55.03 (SD = 17.06) yr. The mean level of serum zinc in the case and control groups were 94.06 (SD = 20/96) mcg/dl and 103.7 (SD = 11.96) mcg/dl, respectively. Independent T-test analysis showed that serum zinc concentration in the case group of bronchiectasis patients was significantly lower than control group (P = 0.02). CONCLUSIONS: The results of our study show that serum zinc level in bronchiectasis patients was lower than the control group and the difference was statistically significant. It seems that the use of zinc supplement can reduce progression of the infectious disease regarding its role in improving the immune system reactions and some unknown mechanisms. Therefore, prophylactic and therapeutic use of zinc must be evaluated in further trials.

Comparison of the Serum Electrolyte Levels among Patients Died and Survived in the Intensive Care Unit.

BACKGROUND: This study aimed to evaluate the prevalence of serum sodium and potassium disorders and assess their effects on mortality rate in hospitalized patients in the ICU and also to identify prognosis and predictors of survival. MATERIALS AND METHODS: A retrospective case-control study was conducted on 457 hospitalized patients in the ICU of Rasoul-e-Akram Hospital (Tehran, Iran). There were two groups: 239 patients who died in the ICU(cases) and 218 patients who were discharged from the ICU(controls). Normal serum concentrations of sodium and potassium were considered as 135-150 and 3-5.5 mEq/L, respectively. Data were analyzed using Chi square test, Independent t-test, One Way ANOVA, Correlation and Receiver Operating Characteristic (ROC) curve. RESULTS: The mean serum sodium concentration in patients who died and discharged patients was 137.56(SD=8.56) and 137.17(SD=5.11) mEq/L, respectively. Whereas, hyponatremia was significantly more common in expired patients (39.7% vs. 28%, P<0.001). On the other hand, the mean serum potassium concentration in expired and discharged patients was 4.42(SD=0.90) and 4.16(SD=0.59)mEq/L, respectively. Hyperkalemia was significantly more common in expired patients (9.2% vs. 0.9%, P<0.001). There was a significant negative correlation between serum sodium concentration and patient's age (P=0.029, R Spearman = - 0.123). In addition, ROC analysis showed that serum potassium concentration could potentially be a predictor of death in ICU patients (P=0.003, Area Under Curve (AUC) = 0.581). CONCLUSION: Hyponatremia and hyperkalemia are highly prevalent in expired ICU patients which is compatible with the findings of some other studies. Mortality of ICU patients is linked, in greater part, to organ dysfunction, but the severity of serum sodium and potassium disturbances remains a significant predictor of mortality. Thus, correcting electrolyte disturbances in ICU patients is important.

Effects of combination of fluticasone propionate and salmeterol xinafoate on lung function improvement in patients with bronchiectasis.

INTRODUCTION: Bronchiectasis is defined as bronchial abnormal and permanent dilation with destructive and inflammatory changes of bronchial wall. Bronchodilators are used to treat the disease in order to improve lung functions. Seretide is the combination of fluticasone propionate and salmeterol xinafoate (FLU/SAL). The effect of each has been proved in the improvement of bronchiectasis, while their synthetic effect as FLU/SAL on bronchiectasis improvement has not been studied yet. AIM: The aim of this study was to investigate the effects of FLU/SAL on the lung function improvement in bronchiectasis patients, comparing and interpreting pulmonary function tests before and after FLU/SAL inhalation. METHODS AND MATERIALS: Twelve patients with bronchiectasis who referred to Rasoul-e-Akram Hospital, Tehran, Iran in 2008 participated in this prospective quasi-experimental trial. The patients were treated with 2 puffs of fluticasone 125 µg and salmeterol 50 µg (Seretide) twice a day for one month. Beside recording demographic variables, the results of pulmonary function tests (PFT) including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and FEV1/FVC ratio were recorded before and after the treatment. Data were analyzed using SPSS v.16 and Pearson correlation and paired T-test were performed. RESULTS: Among 12 patients with bronchiectasis, there were 4 men and 8 women with the mean age of 47.58 (SD=18.32) yr. The mean increase in the ratios of VC, FVC and FEV1 to predicted values and also patients FEV1/FVC after treatment were 15.50% (SD=14.40), 49.83% (SD=8.19) 8.17% (SD=12.07) and 7.17% (SD=12.68), respectively. The results of paired T-test indicated that VC (P=0.008) and FEV1(P=0.039) have increased significantly after treatment. CONCLUSION: This study is one of the first studies investigating the FLU/SAL effect on bronchiectasis. Results of this study have indicated that using FLU/SAL has a significant effect on the improvement of lung function parameters in these patients, while the attention was been focused on antibiotic therapy or other bronchodilators.

Evaluation of the simvastatin effects in the treatment of pulmonary hypertension (PH).

BACKGROUND: Pulmonary hypertension (PH) is a rare but life-threatening disease characterized by significant increases in pulmonary arterial pressure (PAP) and right ventricular hypertrophy (RVH), therefore early diagnosis and proper treatment of PH is very important. Statins confer cardiovascular benefits beyond the reduction of serum cholesterol through antiproliferative and antiinflammatory mechanisms and induction of endothelial nitric oxide expression. In pneumonectomized rats injected with monocrotaline, simvastatin reversed established pulmonary hypertension and conferred a 100% survival advantage. OBJECTIVE: The aim of this study was to evaluate the potential effect of simvastatin treatment in patients with pulmonary hypertension (PH). PATIENTS AND METHODS: In this prospective before-after pilot trial, 19 patients with primary and secondary causes of PH referred to Khorrami Hospital in Qom, Iran were recruited. Patients were treated with simvastatin, beginning at 20 mg/daily for 2 months, then increasing to 40 mg/daily for another 4 months. Echocardiographic Doppler estimates of systolic pulmonary artery pressures (SPAP) were measured for each patient before prescribing simvastatin and at the end of treatment. Also demographic data, history of smoking and heart functional class (NYHA) before and after treatment were recorded. RESULTS: Out of 19 patients with PH, fifteen were males (78.95%) and four were females (21.1%) with the mean age of 66 (SD=15.28) yr, range between 18 to 83 years. The commonest cause of PH was chronic obstructive pulmonary disease (COPD) in 15 patients (78.9%). Simvastatin significantly ameliorated PH from 74.79 (SD=23.52) mmHg to 67.21 (SD=20.55) mmHg (P<0.001). Whereas, heart functional class changes were not statistically significant (P=0.157). CONCLUSION: In this study, we demonstrated that simvastatin treatment decreased SPAP in patients with PH. As the pathogenesis of PH involves inappropriate proliferation and constriction of vascular smooth-muscle cells, and deficiencies of endogenous vasodilators such as prostacyclin and endothelial-derived nitric oxide, the antiproliferative, antiinflammatory and antithrombogenic effect of simvastatin seems to be useful. This study has led physicians to believe that simvastatin may be beneficial for the treatment of PH.