انوشیروان هدایت

Introduction & Colorectal carcinoma is one of the most prevalent cancers. Early diagnosis and diagnosis in primary stages are important in patient’s prognosis. In this study we evaluated factors such as age, sex, stage and tumor location in colorectal patients in five year peroid. From the cancer database of a single referral institution, Shariati Hospital 109 patients who had resection of colorectal cancer from 1999 to 2002 were identified. Cases with recurrent colon cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were constructed using the kaplan-meier method. The factors that were used included: age, sex, TNM stage, T-status, nodal status, distant metastasis, grade, lymphatic and vascular invasion, tumor location, preoperative CEA level and liver function tests. Multivariate analysis of factors was conducted using cox-regression analysis. The mean survival time for all patients was 42.8±2.8) months. The overall 1, 3, 5 year survival rates were 72%, 54%, 47% respectively. The single variable analysis, patients age (P

Colorectal carcinoma metastases are mostly seen in liver. Almost half of the patients with colorectal cancer have liver metastasis or develop liver metastasis during the disease. Any metastasis outside the liver is rarely seen and if present it is usually seen in lungs brain skin and skeletal system with the same probability. Skeletal metastases mostly involve weight bearing bones. Meanwhile skeletal involvement rarely occurs in clavicle. In this paper we report a case of colorectal cancer metastasis to medial head of clavicle.

Introduction & To determine the relationship between serum phosphate, serum calcium, and serum parathyroid hormone levels with parathyroid adenoma weight and postoperative serum calcium in primary hyperparathyroidism. In a prospective study from 2005 to 2007, eighty patients with single parathyroid adenoma entered the study. Preoperative serum calcium, phosphate, parathyroid hormone, alkaline phosphatase and weight of adenomas were recorded. Postoperative serum calcium was measured 24 hours after adenoma resection. Analysis was performed with student T-test and Bivariate correlation. The level of significance was set at P

Introduction & Bilateral neck exploration is the good standard for parathyroid adenoma localization in primary hyperparathyroidism. But not all of surgeon have the necessary experience for accurate surgical exploration. But there are new methods for surgery like unilateral exploration and minimally invasive surgery. Thus, preoperative localization could reduce time and stress of surgery. In a prospective study 80 patients with documented primary hyperparathyroidism through raised serum calcium and parathyroid hormone (PTH), the results of sonographic localization were compared with the findings of surgery and 99mTechnetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients whom adenoma had been localized or not localized through sonography or Sestamibi scan with student’s t-test. In a prospective diagnostic tests accuracy study, 80 patients with primary hyperparathyroidism enrolled. Sonography detected enlarged parathyroid glands in 61 of 80 patients (76.3%), with sensitivity of 83.5% and positive predictive value (PPV) of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients (78.8%) with sensitivity of 85% and PPV of 91.3%. There was no significant deference between sonography and scintigraphy in localization of adenomas. When both sonography and scintigraphy were used for localization, they located 73 adenomas (91.3%), with sensitivity of 97.3% and PPV of 93.5%. Sonography is an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, and overall it is comparable with sestamibi scintigraphy. This study suggests a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test gives negative result.

Introduction & Submucosal hemorrhoidectomy is one the of accepted techniques of surgery but it has never been a popular operation. The advantage of this surgical method is that it minimizes the injury to anoderm and mucosa of anus. The aim of this study was to compare between submucosal hemorrhoidectomy and Ferguson hemorrhoidectomy. In a clinical double-blind controlled trial, 60 patients with grade 3 and 4 hemorrhoids were randomly divided into two groups: 1) submucosal hemorrhoidectomy (30 patients) and 2) Ferguson hemorrhoidectomy (30 patients). These patients were evaluated for early and delayed post operative complications such as pain, bleeding, urinary retention, constipation, fecal impaction, incontinency, surgical site infection, fissure, skin tag, mucosal ectropion, anal stenosis and recurrence. They were regularly followed up at 24 hours, 1 week, 3 months and 6 months after their operation. There were no statistically significant differences between two these groups in terms of age, gender and grade of hemorrhoid(s). Patients treated with submucosal hemorrhoidectomy has significantly less pain within 24 hours after the surgery (P=0.026), but there was no statistically differences between two groups in anal stenosis and other complications. Submucosal hemorrhoidectomy is an effective method in reducing post operative pain within the 24 hours after the surgery and was no case of complicated anal stenosis after 6 months follow up. Other complications in the submucosal technique were similar to those of Ferguson. Submucosal hemorrhoidectomy is comparable with Ferguson technique as a suitable procedure for high grade prolapsed hemorrhoids.

Introduction & In pervious studies it has been shown that gum chewing after elective GI tract operation may stimulate bowel motility and decrease duration of postoperative ileus. The aim of the present study was to assess the effects of sugar free gum chewing after upper GI tract on operation postoperative ileus. In a randomized clinical trial, 50 patients, who were scheduled for elective upper GI surgeries were randomly allocated to 2 groups of gum-chewing group (n=26) and control group (n=24) postoperatively. The patients in the gum-chewing group chewed postoperatively sugar free gum 3 times daily for 1 hour each time until discharge. Patient's demographic characteristics, surgery duration, time to first flatus, time to first bowel movement, and complications were compared. All gum-chewing patients tolerated the gum. The first passage of flatus (72.23±25.52 vs. 92.79±27.35 hours) and time to first bowel movement (95.58±25.88 vs. 110.83±26.18 hours) were significantly lower in the gum-chewing group compared with control group. Gum chewing speeds recovery after the upper GI tract operation. Gum chewing is an inexpensive and helpful care in the upper GI tract postoperative period.

Intra-operative measurement of intact Parathyroid hormone (iPTH) using a rapid assay technique is useful as an aid in determining adequacy of resection and leads to reduce re-operative cases. In a prospective case series study, PTH level determined before and after (intra-operative and one day after) Parathyroidectomy in 34 patients with primary hyperthyroidism that refer to Shariati hospital during 18 months between year 2000 and 2001. The average PTH levels before and after parathyroidectomy were 563 pgr/lit and 121 pgr/lit. All patients had significant decrease in PTH levels after Parathroidectomy (mean = 78%). One day after operation, this level decreased to 42 pgr/lit (mean = 87% decrease compared with before operation) In this study, like the same other studies from other countries there was significant decrease in PTH levels in rapid intra-operative assay that can demonstrate the reliability of PTH monitoring for intra-operative management and overall operative success rates.