A Case Report: An Unusual Variation in the Facial Artery.

The facial artery is the main artery supplying the face occasionally. It gives three branches on the face, the inferior labial, the superior labial, and the lateral nasal, and terminates as the angular artery. Due to congenital vascular variations in the facial artery, it has been considered in the dissection of the head and neck region. During the dissection of a 65-year-old woman to expose this region, we discovered that the left facial artery is terminated by the superior labial artery after giving off the submental and inferior labial branches. At the level of the left oral commissure, the facial artery was attached to the buccinator muscle as connective tissue, with a noticeable decrease in diameter. The purpose of this study is to report a new variation of the facial artery that is particularly important for cadaver dissection, and head and neck surgeries, as well as for facial artery angiography.

Quality of life outcomes in patients living with stoma.

BACKGROUND: Despite efforts to maintain the intestinal tissue and treat gastrointestinal disease, a large number of patients undergo ostomy surgery each year. Using stoma reduces the patient's quality of life (QOL) greatly. Although there are approximately 3000 patients in Iran; there is little information about the impact of stoma on their QOL. AIMS: The study aims to evaluate QOL of stoma patients using a special measurement tool. SETTINGS AND DESIGN: This survey was a cross-sectional study that was conducted on 102 random samples of stoma patients. MATERIALS AND METHODS: The City of Hope Quality of Life-Ostomy Questionnaire was used for collecting demographic and clinical information and evaluating QOL. STATISTICAL ANALYSIS USED: Univariate and multiple regression analyses were performed to identify predictors of QOL. RESULTS: The mean score for the overall QOL for stoma patients was 7.48 ± 0.9. 70% of patients were dissatisfied with sexual activities. More than half of them reported feelings of depression following stoma surgery. Univariate analysis indicated that factors such as the type of ostomy (temporary/permanent), the underlying disease that had led to the stoma, depression, problem with location of ostomy, and change in clothing style had significant effects on overall QOL and its subscales (P < 0.05). The results of the regression analyses showed that only depression and problem with the location of ostomy were statistically significant in predicting patients' QOL and its subscales (P < 0.05). CONCLUSIONS: The findings demonstrated that living with stoma influences the overall aspect of QOL. Education for the patients and their families is important for improving the stoma patients' QOL. Sexual and psychological consultation may also improve patients' QOL.

Therapeutic effects of human adipose mesenchymal stem cells and their paracrine agents on sodium iodate induced retinal degeneration in rats.

AIMS: The degeneration of retinal neurons which occurs in many neurodegenerative diseases of retina such as retinitis pigmentosa and aged-related macular degeneration, is a progressive phenomenon and leads to permanent visual disability. Aside from their economic and social impact, those who suffer from these diseases have a poor quality of life due to the lack of cures. Researchers have turned to stem cell therapies as a potential solution to this global health crisis. Mesenchymal stem cells (MSCs) and their paracrine agents such as conditioned medium (CM) and exosomes (Exo) have been applied to treat different retinal disorders. This study compared the therapeutic effects of human adipose mesenchymal stem cells (hADSCs) and their secretome on an in vivo model of sodium iodate retinal neurodegeneration. MAIN METHODS: We analyzed the expression of retinal cells' specific mRNAs by RT-PCR and proteins by immunostaining as well as performing visual cliff avoidance test as a functional evaluation technique. There were four therapeutic groups in this study: hADSC, hADSC-CM, hADSC-Exo and hADSC-Exo + CM. KEY FINDINGS: Although all groups showed different therapeutic effects on various retinal cells, the results of hADSC-CM were most striking, especially in terms of photoreceptor regeneration and retinal function. SIGNIFICANCE: The findings of present study demonstrated the different effects of MSC-based therapies on various retinal cells which could be helpful in designing more precise treatments that suit to each neurodegenerative disease mechanism and the cells involved. It also suggests that CM might be a better choice due to its multifactorial characteristic.

Pomegranate seed extract enhances the inhibitory effect of adipose-derived mesenchymal stem cells on breast cancer cell line in co-culture conditions.

Background and purpose: Pomegranate seed extract (PSE) possesses anticancer activities and healing effects. Adipose-derived stem cells (ADSCs) are being considered a new candidate for cancer treatment. The purpose of this study was to investigate the effect of PSE on the cell cycle and apoptosis of the MCF-7 cell line in the co-culture condition with ADSCs. Experimental approach: MCF-7 and ADSC cells (ratio 1/1) were cultured in a transwell plate with and without PSE (PSE-co-culture and co-culture groups). MCF-7 cells were cultured in monolayer without and with PSE (mono-culture and PSE-mono-culture groups). MCF-7 cell line was harvested on day 5 and cell viability, apoptotic activity, cell cycle, and gene expression were evaluated. Findings / Results: The results of the MTT assay indicated that PSE at 100 µg/mL has the highest cytotoxicity on the MCF-7 in the PSE-co-culture group. The cell cycle analysis revealed that ADSCs in combination with PSE significantly increased the population of MCF-7 cells in the G1 phase, resulting in the arrest of MCF-7 cells cycle in the G0/G1 transition. In addition, the most apoptotic MCF-7 cells (41.5%) were detected in the same group. Expression of BAX and caspase3 genes were upregulated while anti-apoptotic (BCL-2) and angiogenesis inducer (VEGF) genes were downregulated in the PSE-co-culture group compared with the other groups. Conclusion and implications: ADSCs reduced cell viability and proliferation of MCF-7 cells in co-culture conditions and adding PSE to the medium increased the apoptosis of cancer cells. This study suggests that ADSCs with PSE can suppress tumor cells.

Therapeutic effects of mesenchymal stem cells-derived extracellular vesicles' miRNAs on retinal regeneration: a review.

Extracellular vesicles (EVs), which consist of microvesicles and exosomes, are secreted from all cells to transform vital information in the form of lipids, proteins, mRNAs and small RNAs such as microRNAs (miRNAs). Many studies demonstrated that EVs' miRNAs have effects on target cells. Numerous people suffer from the blindness caused by retinal degenerations. The death of retinal neurons is irreversible and creates permanent damage to the retina. In the absence of acceptable cures for retinal degenerative diseases, stem cells and their paracrine agents including EVs have become a promising therapeutic approach. Several studies showed that the therapeutic effects of stem cells are due to the miRNAs of their EVs. Considering the effects of microRNAs in retinal cells development and function and studies which provide the possible roles of mesenchymal stem cells-derived EVs miRNA content on retinal diseases, we focused on the similarities between these two groups of miRNAs that could be helpful for promoting new therapeutic techniques for retinal degenerative diseases.

Prognostic factors in gastric cancer using log-normal censored regression model.

BACKGROUND & OBJECTIVE: Gastric cancer is one of the most common cancers in the world. It is rarely detected early, and the prognosis remains poor. Cox proportional hazard model is used to examine the relationship between survival and covariates. Parametric survival models such as log normal regression model can also be used for this analysis. We used log normal regression model in this study to evaluate prognostic factors in gastric cancer and compared with Cox model. METHODS: We retrospectively studied the 746 patients diagnosed with gastric cancer admitted in a referral hospital in Tehran, Iran, from February 2003 through January 2007. Age at diagnosis, sex, extent of wall penetration, histology type, tumour grade, tumour size, pathologic stage, lymph node metastasis and presence of metastasis were entered into a log normal model. Hazard rate (HR) was employed to interpret the risk of death and the results were compared with Cox regression. The AIC (Akaike Information Criterion) was employed to compare the efficiency of models. RESULTS: Univariate analysis indicated that with increasing age the risk of death increased significantly in both log normal and Cox models. Patients with greater tumour size were also in higher risk of death followed by those with poorly differentiated and moderately differentiated in tumour grade and advanced pathologic stage. The presence of metastasis was significant prognostic factor only in log normal analysis. In final multivariate model, age was still a significant prognostic factor in Cox regression but it was not significant in log normal model. Presence of metastasis followed by histology type were other prognostic features found significant in log normal results. Based on AIC, log normal model performed better than Cox. INTERPRETATION & CONCLUSION: Our results suggest that early detection of patients in younger age and in primary stages and grade of tumour could be important to decrease the risk of death in patients with gastric cancer. Comparison between Cox and log normal models indicated that log normal regression model can be a useful statistical model to find prognostic factors instead of Cox.

Uninvestigated dyspepsia and its related factors in an Iranian community.

OBJECTIVE: To determine the prevalence and determinants of uninvestigated dyspepsia in the Iranian population. METHODS: A cross-sectional study conducted in Tehran province from May 2006 to December 2007, included 18,180 adult persons selected randomly. The study took place at Shahid Beheshti University, MC, Tehran, Iran. A questionnaire was completed in 2 steps. In the first part, personal characteristics and 11 gastrointestinal symptoms were inserted. Those who reported at least one of these 11 symptoms were referred for the second interview, which consisted of questions on different gastrointestinal disorders based on Rome III criteria, including uninvestigated dyspepsia. RESULTS: The prevalence rate of uninvestigated dyspepsia was 8.5% (10.9% in women and 6.4% in men). Among the subjects diagnosed with dyspepsia, bothersome postprandial fullness was the most common symptom (41.5%). Uninvestigated dyspepsia was more common in low educated and widowed participants. Approximately 41.4% of patients had a history of depression, and 66.1% had self report of stress. The prevalence of functional irritable bowel syndrome in patients with uninvestigated dyspepsia was 8.3% and gastroesophageal reflux disease was 64.9%. CONCLUSION: Uninvestigated dyspepsia has a less common prevalence in the general Iranian population than developed countries. Women, older, obese, widowed, and low education subjects are more likely to suffer from dyspepsia.

Comparing Cox regression and parametric models for survival of patients with gastric carcinoma.

BACKGROUND: Researchers in medical sciences often tend to prefer Cox semi-parametric instead of parametric models for survival analysis because of fewer assumptions but under certain circumstances, parametric models give more precise estimates. The objective of this study was to compare two survival regression methods - Cox regression and parametric models - in patients with gastric adenocarcinomas who registered at Taleghani hospital, Tehran. METHODS: We retrospectively studied 746 cases from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were selected as potential prognostic factors and entered into the parametric and semi parametric models. Weibull, exponential and lognormal regression were performed as parametric models with the Akaike Information Criterion (AIC) and standardized of parameter estimates to compare the efficiency of models. RESULTS: The survival results from both Cox and Parametric models showed that patients who were older than 45 years at diagnosis had an increased risk for death, followed by greater tumor size and presence of pathologic distant metastasis. CONCLUSION: In multivariate analysis Cox and Exponential are similar. Although it seems that there may not be a single model that is substantially better than others, in univariate analysis the data strongly supported the log normal regression among parametric models and it can be lead to more precise results as an alternative to Cox.

Evaluation of endoscopic characteristics of upper gastrointestinal polyps in patients with familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) is a disease inherited in an autosomal dominant fashion. Most FAP patients develop upper gastrointestinal polyps; especially those in the antrum and duodenum are usually neoplastic. The aim of this study was to evaluate the prevalence of gastroduodenal polyps in Iranian FAP patients. MATERIALS AND METHODS: 28 patients affected by FAP underwent front-view and side-view endoscopy. Papillary biopsies were performed in all patients. Location of polyps, their number and size, pathology study, patient general information (gender, age, family history of FAP or colorectal cancer and gastroduodenal polyps) were analyzed. RESULTS: Gastric polyps were seen in 39.3 % of patients. Some 72.7% of the affected individuals had fundic gland polyps and 36.36% had hyperplastic polyps. Duodenal adenoma was observed in 25% of patients. While 57% of patients had tubular adenoma with low grade dysplasia, 42.8% showed tubulovillous adenoma with low grade dysplasia. CONCLUSIONS: Findings of this study indicated that the prevalence of gastroduodenal polyps in FAP patients is high and dysplasia may be evident in duodenal polyps. Therefore, it appears that routine gastroduodenal endoscopy in FAP patients is necessary.

Epidemiological features of hepatitis B and C infection in a high risk population: results of screening programs.

AIM: The aim of this study was to report the epidemiological features of HBV & HCV infection in an Iranian high risk population. BACKGROUND: Hepatitis B and hepatitis C infections are worldwide serious public health problems. Iran has an intermediate prevalence of infection and a screening program was started in 2010 among high risk individuals. PATIENTS AND METHODS: This cross-sectional study was conducted on 4455 new patients during two past years. Demographic information, age, gender, occupational status, medical history, history of vaccination against HBV, high risk exposure and laboratory findings were collected for each patient. Then distribution of demographic and risk factors was evaluated in each type of hepatitis. RESULTS: The mean age of patients was 45.6±17.3 years. More than two-thirds of the diagnosed cases were infected with HBV. 74% of patients were carriers of hepatitis virus. 60% of patients had no symptoms at diagnosis. Illicit intravenous drug use was most common high risk exposure in patients under study (n=366, 8.2%). High risk behaviors including illicit intravenous drug use and unprotected sex were relatively higher in patients infected with hepatitis C compared to patients with hepatitis B infection. CONCLUSION: Findings of this study suggest that illicit intravenous drug use, contact with an infected household member and unprotected sex are the most common high risk exposure in Iranian patients infected with viral hepatitis. Therefore, preventive strategies such as health education, vaccination and screening programs should be directed to these groups. The results also show that a majority of patients have no symptoms at the time of diagnosis, therefore periodic screening tests in high risk groups is required.

Specific count model for investing the related factors of cost of GERD and functional dyspepsia.

AIM: The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors. BACKGROUND: Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper. PATIENTS AND METHODS: This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models. RESULTS: According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant. CONCLUSION: PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR.

Direct medical care costs associated with patients diagnosed with chronic HCV.

BACKGROUND: HCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial. OBJECTIVES: This study aimed to estimate the direct medical care costs of chronic HCV infection. PATIENTS AND METHODS: For this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$). RESULTS: Average direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs. CONCLUSIONS: According to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).

An overview of colorectal cancer survival rates and prognosis in Asia.

Colorectal cancer is a rapidly rising trend in Asia. The incidence in many Asian countries is on par with the West. Several studies have provided data regarding the survival of patients with colorectal cancer. In Asia, the overall cure rate of colorectal cancer has not improved dramatically in the last decade, 5-year survival remaining at approximately 60%. Colorectal cancer survival time has increased in recent years, but mortality rate remains high. Although studies have determined a number of factors that can predict survival of patients after diagnosis, life expectancy has not been increased dramatically. It seems that among the prognostic factors explored so far, the most important are those that relate to early diagnosis of cancer. Primary detection is feasible since efficient screening modalities are available. Colonoscopic surveillance is needed, especially in subjects at higher risk.

History of upper gastrointestinal cancers in relatives: a community-based estimate.

AIM: The present study aimed to evaluate the prevalence of positive family history of these cancers in a large population-based sample of Tehran province, capital of Iran. BACKGROUND: Upper gastrointestinal (UGI) cancers (gastric and esophagus cancer) constitute a major health problem worldwide. A family history of cancer can increase the risk for developing cancer and recognized as one of the most important risk factors in predicting personal cancer risk. PATIENTS AND METHODS: This study designed as a cross-sectional survey in general population (2006-2007) of Tehran province. Totally 7,300 persons (age > = 20 years) sampled by random sampling on the basis of the list of postal, of whom 6,700 persons agreed to participate (response rate 92%). Respondents were asked if any first-degree (FDR) or second-degree (SDR) relatives had gastric or esophageal cancer. RESULTS: Totally, 6,453 respondents (48% male) entered to the study. The mean age of responders with positive FH was significantly higher than those with negative FH (P < 0.05). In total, 341 respondents (5.3%) reporting a history of UGI cancers in their relatives, 134(2.1%) in FDRs, and 207(3.2%) in SDRs. CONCLUSION: Our findings showed that the reported prevalence of FH of UGI cancers was relatively low and varied by specific respondent characteristics such as age and sex. However, the estimates of prevalence presented here are likely to be conservative compared with actual prevalence because of self-reported data gathering.

Clinical profile and post-operative lifestyle changes in cancer and non-cancer patients with ostomy.

AIM: The aim of this was to investigate some clinical profiles and lifestyle changes in stoma patients. BACKGROUND: Stoma patients experienced multiple complications due to their ostomy formation. PATIENTS AND METHODS: A cross-sectional study performed on 102 random samples of stoma patients. Any patient with adequate physical and mental capability to participate and having had an ostomy in place for at least 3 months was eligible to enter the study. Participants asked to answer study questions concerning age, sex, type of stoma, having permanent or temporary ostomy, underlying cause of stoma formation, type of cancers cause of stoma. Patient also questioned about some lifestyle changes because of stoma including: changing diet, sexual satisfaction (if sexually active after stoma formation), sense of depression, changing job, change clothing style. RESULTS: Colostomy was the most common type of stoma followed by ileostomy and urostomy. In 80.4% of patients under study the stoma was permanent. Most patients had a stoma because of cancer (77.5%), with colon cancer (41.2%) being the most common malignant diagnosis. The mean age of cancer patients (56.1±10.9) with stoma was significantly higher than non-cancer patients (44.7±12.9) (p < 0.05). A significant differences were found regarding to sexual satisfaction after stoma formation between the two groups (p < 0.05) and the cancer group was less sexually satisfied post-ostomy. CONCLUSION: In conclusion, stoma formation can caused multiple problems for both cancer and non-cancer patients. Counseling of patient is an important component of care that could help stoma patients to adjust with new situations.

Epidemiological features of gastro-esophageal reflux disease in Iran based on general population.

AIM: The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence. BACKGROUND: Gastro-esophageal reflux disease (GERD) is a common and chronic problem. Recent reports from developing countries indicate increment in the incidence and prevalence of the disease over the past. PATIENTS AND METHODS: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms. RESULTS: Altogether 18180 individuals participated in this cross-sectional study. The mean ± SD age of participant was 38.7±17.1 and 9072 (49.9%) were women. The prevalence of GERD was 8.85 (8.43-9.26). There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome (IBS) and uninvestigated dyspepsia (UD). CONCLUSION: According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years.

Estimation of average diagnosis and treatment costs of hepatitis C.

AIM: The objective of this study was to estimate the average cost of diagnosis and treatment of hepatitis C among patients based on their treatment regime, during the one course of treatment and six-month after stopping that. BACKGROUND: Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide and a major public health problem. PATIENTS AND METHODS: All data for this cross-sectional study were collected from medical records of 200 patients with hepatitis C, who referred to a private gastroenterology clinic between years 2005 through 2009. Information related to the 200 patients was extracted from their medical records and finally, 77 patients of them, who their treatment was not interfering with any other disease entered in this study. Therefore diagnosis and treatment costs of these patients were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$). RESULTS: Mean costs of diagnosis and treatment in one course of treatment and six month after that with standard interferon plus ribavirin (INF-RBV) exceeds 3,850 PPP$ and for patients who treated with peg-interferon plus ribavirin (PEG-RIBV) was 16,494 PPP$. Also in both types of treatment, medication cost was found to be a dominant cost component. CONCLUSION: Hepatitis C represents a very important and potentially costly disease to managed care organizations. Patients with this disease require expensive drug therapies and consume significant health care resources.

Using statistical models to assess medical cost of hepatitis C virus.

AIM: This study compared PR and NB in predicting HCV patient costs. The objective of this study was to predict the direct cost of the HCV patient in Iran. BACKGROUND: Hepatitis C virus (HCV) is a common and expensive infectious disease in Iran. Cost associated with HCV and its complications has not been well characterized. Analysis of cost data is important in providing consistent information to aid budgeting decisions and certain statistical regression models need for prediction mean costs. Poisson regression (PR) and negative binomial regression (NB) are more common in cost prediction study. PATIENTS AND METHODS: This study designed as a cross-sectional clinic base from 2001 to 2010. First treatment period of each patient bring in study. We evaluated the doctor visiting, drugs, and hospitalization and laboratory tests of patients. Cost per person per one treatment period estimated in purchasing power parity dollars (PPP$). The PR is one of the models from general linear models (GLM) for describing count outcomes. The NB is another model from (GLM) as an alternative to the PR model. RESULTS: According to Likelihood ratio test NB was found to be more appropriate than PR (P < 0.001). Genotype, marriage, medication, and SVR were being significant. Genotype 3 versus 1 decreasing cost while marriage, consuming pegasys and SVR increasing. CONCLUSION: Choosing best model in cost data is important because of specific feature of this data. After fitting the best model, analyzing and predicting future cost for patient in different situation is possible.

Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data - implications for screening.

INTRODUCTION: Design and implementation of screening programs in each country must be based on epidemiological data. Despite the relatively high incidence of CRC, there is no nationwide comprehensive program for screening in Iran. This study was designed to investigate national CRC data and help to determine guidelines for screening. METHODS: Incidence data used in this study were obtained from Iranian annual of National Cancer Registration report. Age standardized rates (ASR)were calculated using world standard population and were categorized by age, sex, anatomic subsite and morphology of tumor. Data were analyzed using SPSS.V.13 and Open Source Epidemiologic Statistics for Public Health software (OpenEpi v.2.3.1). RESULTS: A quarter of cases were less than 50 years of age. The majority of tumors were detected in the colon. The overall ASR in the four years period was 38.0 per 100000 and was higher for men compared women (P<0.05). Incidence rate of colorectal cancer increased with age. CONCLUSION: Results of present study indicated that incidence of colorectal cancer is relatively high in Iran. Incidence of CRC in people under 50 years and in rectum were reported higher than other countries that related etiologic factors should be investigate in further studies. According to the increasing of ASR after age 50 years, it seems that onset of screening at age 50 would be appropriate.

Increased oesophageal cancer mortality rate in Iran.

BACKGROUND AND STUDY AIMS: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer. PATIENTS AND METHODS: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardised rate (ASR). RESULTS: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age. CONCLUSION: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade.