فهرست مطالب محمد منصور ساروی

Gastric cancer is one of the most prevalent cancers of digestion system. Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of death worldwide. Many prognostic factors identified to affect the survival rate include age, depth of tumor invasion to gastric wall, grade, tumor diameter and regional lymph node involvement. In areas without screening for gastric cancer, diagnosis are late and have a high frequency of nodal involvement. It is important to evaluate LN status preoperatively for proper treatment strategy.
We reviewed 90 patients with gastric cancer who had gastrectomy over a 5-year period (2010-2015) using a retrospective study design.
Our study showed a high incidence of lymph node involvement in patients (73%) and most of them had N3 involvement. The study consisted of 65% male with ratio of 1.94:1 and ranged from 23-83 (mean age 63). Most patients were at grade III, stage IV, and most tumors had above 4cm in diameter and invasion to subserosa (T4). The most frequent clinical sign was epigastric pain, followed by loss of appetite and weight. The correlation between the lymph node status and other parameters showed that the maximum risk for nodal metastasis depend on tumor diameter and depth of invasion.
In this study high incidence of LN metastasis shows that gastric cancer diagnoses late in advanced stages because of lack of screening methods and knowledge about disease. Due to high frequency of disease in this area, it is necessary to have screening methods for earlier diagnose and increase the rate of 5-year survival.

Cancer is a devastating chronic disease that affects all aspects of life. Lifestyle is an important factor which is related with higher incidence of breast cancer, and it can be modified by education. Investigation of the role of lifestyle on the incidence of cancer in women needs special attention. This study aimed to assess the lifestyle in women with breast cancer. This was a descriptive study. The sample was 60 patients admitted in oncology ward of Imam Sajad Hospital, Ramsar for chemotherapy in 2015. Lifestyle in patients assessed by lifestyles questionnaire (LSQ). Data analyzed by descriptive statistics, Chi-square test and SPSS software. The lifestyle scores in five cases (8.33%) were undesirable, in 47 cases (78.33%) were relatively desirable, and eight cases (13.34%) had a desirable level of lifestyle. The chip-square test showed there was not significant relationship between the lifestyle and the elapsed time of cancer diagnosis, age, job, estrogen & progesterone receptor and menopause on subjects. (P>0.05) The relationship between lifestyle and education level, marital status, HER-2 oncogenes were significant (P Although our study results showed better lifestyle scores than previous studies, but they were significantly lower than ideal levels. With proper counseling and interventions (e.g. teaching relaxation techniques, appropriate physical activity, healthy diet, maintaining proper sleep patterns, and stress management) the lifestyle of patients can be promoted.

Introduction and Aims: Bone metastases have bad potential effects on the individual life period. One of these complications is hypercalcemia that cause dizziness, nausea, constipation and azotemia. Pamidronate reduces skeletal complications in patients with bone metastases. This study evaluated effect of Pamidronate on hypercalcemia BUN and Cr in cancer patients.
In this quasi-experimental study, 41 patients with malignancy referring to Ramsar Imam Sajjad hospital were selected by convenience sampling. In this study 90 mg of Pamidronate was injected intravenously monthly for 3 months. Data collection was done through demographic and clinical data questionnaire and blood samples. Data of before and after intervention were compared. Statistical analysis was performed using paired t tests, chi-square, Friedman and Wilcoxon tests with SPSS v.11.5 and P The most common cancer was breast (43.9%) and bone metastasis point in most patients (65.9%) was diffuse. The results of this study indicated that there was significant difference between serum Ca (calcium) (P=0.015), BUN (Blood Urea Nitrogen) (P=0.031), ALKP (Alkalin Phosphatase) (P=0.002) before and after treatment, but there was no significant difference between Cr (Creatinine) concentration before and after treatment (P=0.41).
Pamidronate is effective in prevention of hypercalcemia and decrease BUN and Cr. So, it can be used as main and routine treatment.

Breast cancer is the most common kind of cancer in women and the major cause of cancer death in women 20-59 years. Identification of prognostic fac-tors in breast cancer, and knowing the rel-ationships between them can be useful in clinical decision-making and choosing ap-propriate treatment. This study was an across-sectional retrospective one that was conducted on 220 women with primary breast cancer who referred to oncology clinic of Immam Sajjad hospital in Ramsar during 2002-2012. Data were collected by a Checklist and using the information in the patient's medical records. Information had been analyzed by using statistical software SPSS 16 with descriptive - analytic statistical tests (frequency percentage and Chi square test). The significance level was considered < 0.05 in this study. 77.3% of patients were aged less than 55 years, and 35% of patients were po-stmenopausal. HER-2/neu over expression in 38.2%, and P53 gene mutation in 52.3% of patients were found. ER on 69.1% and PR in 63.6% of cases were positive. In this study, there was a statistically significant relationship between HER-2/ neu bio-marker status with tumor size (P=0.0001), P53 biomarker status with tumor pathology (P=0.042), ER biomarker status with disease stage (P=0.034), ER status with pathological grade (P=0.004), PR biom-arker status with pathological grade (P=0. 011) and PR biomarker status with disease Stage and pathological grade (P=0.037). In the other cases, there was not any statis-tically significant relationship between biomarker status and other prognostic fac-tors in this study (P>0.05). Discussion & According to the findings of this study, there was a rel-ationship between HER-2/neu status with tumor size, ER& PR status with disease Stage and pathological grade, P53 with tumor pathology. So determining the biolo-gical markers status (HER-2/neu, PR, ER, P53) in patients with breast cancer, and the onset of anti-estrogen therapy in patients with steroid receptors and anti HER-2/neu treatment of those tumors with HER-2/neu over expression is recommended.

Chronic sinusitis is one of the most common causes of referring to physician and creates longterm discomfort for people. The common bacterial organisms include: Streptococcus pneumonia, Hemophillous influenza, Moraxella catarrhalis, Staphylococcus aurous, biofilm and superantigen produced by some of these bacteria should be considered. This study aimed to compare the efficacy of Doxycycline, Azithromycin and Clarithromycin in the treatment of chronic bacterial rhinosinusitis. In this clinical trial, 55 patients with a mean age of 36 years with chronic bacterial rhinosinusitis who were documented clinically and by imaging (CT Scan), were treated in three groups with Doxycycline (100mg BD), Azithromycin (8mg/kg BD), and Clarithromycin (500mg BD). The patients were followed by clinical signs, symptoms and imaging. Data were analyzed by SPSS software and Chi Square, Anova and T test. At the end of treatment, Doxycycline’s treatment success rate was higher than Azithromycin and Clarithromycin (the clinical cure rates respectively were 73 % versus 57% and 40%, and CT Scan cure rate results respectively were 70% versus 33% and 25%). The results of present study indicated that the Doxycycline in the treatment of chronic bacterial rhinosinusitis was more effective than Azithromycin and Clarithromycin in clinical response and improved CT Scan results.

Neutropenia is the strongest factor associated with infection in neutropenic patients with immunodeficiency and under immunosuppressive medication with fever being the most important indicator of infection in neutropenic patients. Since infections are the commonest cause of death in these patients, this study was performed to determine the causes of fever in neutropenic patients. This cross-sectional study was performed on 63 patients hospitalized with febrile neutropenia, admitted in the oncology ward of Imam Sajjad Hospital during 2006-2011. Sampling was performed by available sampling techniques and data collection was performed by checklist. The data were analyzed using statistical software SPSS 16. The significance level was considered to be less than 0.05 in this study.Out of the total number of patients, 39.7% were male and 60.3% female. The mean age of patients was 51.83 ± 17.06 years. Culture was positive in 54% patients (33.36% F, 20.64% M). The most common types of infection were urinary tract (14.3%) and respiratory infections (7.9%). The most common isolated microorganism was Escherichia Coli (26.5%). The findings of most studies show that gram-positive bacteria are the most common cause of fever in neutropenic patients.

Fatty liver disease is characterized by deposition of fat droplets in the liver of patients. According to some epidemiological studies; BMI، amount of fat intake from foods and high central fat are risk factors of breast cancer. This issue is one of the factors that cause high incidence of fatty liver in patients with breast cancer. In this cross-sectional descriptive study، all patients with breast cancer were evaluated who referred to Imam Sajjad hospital of Ramsar during 2008 - 2011. After initial review، 100 patients were enrolled. Those who were treated by chemotherapy underwent abdominal Sonography for evaluation of fatty liver. Also، those patients who also received tamoxifen in addition to chemotherapy، underwent abdominal ultrasonography 6 months after taking tamoxifen. After that، relationship between treatment of breast cancer and fatty liver in studied patients was evaluated based on obtained information. The study results revealed that after chemotherapy، 30 (30%) patients were reported to have fatty liver. Out of 70 people that after chemotherapy did not have fatty liver، 62 patients received tamoxifen; and after taking tamoxifen، 45. 2% developed fatty liver. Using Chi Square test، there was a significant relationship between fatty liver after receiving tamoxifen، hyperlipidemia (p=0. 011) and getting overweight (P =0. 017). As the findings indicated، treatment of breast cancer especially with tamoxifen is associated with increased risk of fatty liver، especially in women who have hyperlipidemia and are overweight.

Gastric cancer is considered as one of the most prevalent cancers, such that in our country it is on the top of prevalent cancers. Because of the high prevalence of this cancer in north of Iran, in spite of its incidence decrease in many regions of the world, we decided to determine the epidemiological and malignancy properties of gastric cancer in this region This research is a descriptive study (based on existing data). The study population consisted of gastric cancer patients referred to oncology clinic at Ramsar Imam Sajjad hospital during 2002- 2009. Necessary information was extracted from their medical files and pathology reports, and statistically analyzed. In this Study, 144 patients were assessed (103 males and 47 females). In 95.8% of patients, tumor was adenocarcinoma. In 45.1% tumor was located in antrum. In 48.6% tumor was poorly differentiated. 72.9% of subjects had positive lymphatic involvement. There was metastatic involvement in 31.9% of patients, and the most common organ for metastasis was liver. 46.5% of Patients were in stage 4 at the time of referring to hospital and in 38.2% of cases tumor has been progressed to T2 Level. By considering this fact that most referring patients (46.5%) were in stage 4 when were diagnosed and had poorly differentiated carcinoma, it is recommended that people should consider abdominal discomfort as a serious problem and do necessary diagnostic methods especially in ages above 45 years with especial emphasis on early diagnosis of disease and reduction of death rate for at risk population.

Sarcoidosis is a multisystem chronic disorder of unknown etiology that affects all of the organs, but the most commonly involved organs are the lungs. Pulmonary involvement is reported in 90% of patients and splenomegaly is reported in 20% of cases. In this study, we report one patient with sarcoidosis and splenomegaly without pulmonary involvement. Patient was a 52 years old, married housewife who referred to the hematology clinic with complaints of anemia, weight loss and high sedimentation. Results revealed minor normochromic normocytic anemia and splenomegaly. Because of low reticulocyte count and high ESR, biopsy and bone marrow aspiration was done to exclude malignancies and results showed erythroid hyperplasia and minor eosinophilia. Diagnostic splenectomy was also done and pathology reports of liver& spleen biopsy showed granulomatous inflammation and the presence of noncaseating granulomas in the involved organs. Final diagnosis was “Granulomatous inflammation” and the presence of noncaseating granulomas due to sarcoidosis. Patient was treated with prednisone. After splenectomy and onset of treatment, clinical presentation improved and patient gained weight. After one year of treatment and follow up, patient had no apparent clinical problem and treatment was stopped. Sarcoidosis is a rare disorder in Iran and difficult to differentiate from other liver & spleen disorders. It is necessary that proper diagnostic tests should be done for all patients so as to diagnose and treat sarcoidosis patients on time and prevent complications.

Considering the importance of breast cancer, identifying the factors that may either directly or indirectly determine the final prognosis of afflicted patients is helpful in clinical decision making, clinical approach and treatment of disease. Determination, expression and evaluation of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor (Her-2/neu) and p53 gene are somehow effective in prognoses and treatment of the disease. The purpose of this study is to recognize if any relationship exists between Her-2/neu gene amplification and estrogen receptor (ER), progesterone receptor (PR) and p53 gene among female with breast cancer. This descriptive cross-sectional study is performed on 67 women with primary breast cancer whom were hospitalized at oncology ward in Emam Sajjad Hospital (Ramsar, Iran, 2001-2005). Data were gathered from participants medical records, based on Her2/neu gene amplification, estrogen receptor (ER), progesterone receptor (PR) and p53 gene. Samples were evaluated by semi-quantitative immunohistochemistry method using Her-2/neu gene amplification kit, along with ER, PR and p53 gene amplification kits. Data were analyzed by descriptive and analytic statistic tests. It was revealed that 50.7% of studied cases had positive ER, whereas 43.3% were PR positive, 31.3% were p53-positive and 31.3% had positive Her-2/neu. Her-2/neu gene was amplified in 14.2% of ER/PR positive cases andin 66.7% of ER/PR negative subjects. Uusing Chi-square test it was revealed that there is statistically significant correlations between Her-2/neu expression and positive ER (p<0.030), positive PR (p<0.014), simultaneous expression of ER and PR (p<0.001), negative PR and ER expression(p<0.004) and positive family history for cancer (p<0.003), respectively. In addition, no correlation was found between Her-2/neu expression and p53 gene, age, menopause and marital age of patients. Regarding the significant correlation between Her-2/neu amplification and state of estrogen/progesterone receptors, and more significant correlation between Her-2/neu amplification and estrogen/progesterone receptor-negative tumors we can apply exclusive treatment modalities.

In cancer patients various infections were developed due to severe neutropenia resulted from chemotherapy. There is controversy between initial monotherapy or multidrug prescription. The purpose of this study was to compare the efficacy of ceftazidime and imipenem in control of fever in cancer patients with febrile neutropenia. Materials ands 40 patients with cancer, fever and neutropenia (PMN<500), without recognized source of infection, were selected using the convenience and consecutive method. Using a random sampling, twenty patients were treated with imipenem (500mg Iv/Q8hr) and others with ceftazidime (2mg Iv/Q8hr). The criteria for positive response to the drugs were: fever disappearance during maximally 72 hours lasted for up to 24 hours, and increased neutrophil counts more than 500/ml. Our results show that 60% and 55% patients with ceftazidime and imipenem were cured, respectively. 40% patients treated with ceftazidime and 45% patients treated with imipenem needed another antibiotic therapy at the same time. No significant relationship was found between different types of drug regime among the groups. Findings of this study indicate that ceftazidime and imipenem have similar efficacy in treatment of febrile neutropenic patients. Due to more availability and lower cost of ceftazidime than imipenem, ceftazidime is suggested as first line treatment in febrile neutropenia

Background and Although adjunct chemotherapy may increase life in non-menopausal breast cancer patients, however, it may cause short-term complications such as nausea, vomiting, alopecia, as well as long-term complications in ovarian failure and premature menopausal. The objective of this study was to investigate chemotherapy-induced secondary amenorrhea in non-menopausal women with breast cancer. A descriptive design (case series) was preformed on fifty breast cancer patients, non-menopausal (normal mense) and chemotherapy in Ramsar Emam Sajad Hospital Oncology unit from 2007 to 2008. Sampling was consecutive. Data gathering method was questionnaire & blood sampling (FSH & Progesterone) for prior and 12 months after the end of chemotherapy. Data was analyzed by paired-t, independent-t and one-way ANOVA tests. Results showed that 62% of patients were amenorrhea 12 months after the end of chemotherapy. Results showed that there was no meaningful relationship between age, hormone therapy, disease stage, node-positive and ER & PR status to amenorrhea; however, there was a meaningful relationship between duration of treatment, type and dose of chemotherapy to amenorrhea. In pre-menopausal patients with breast cancer, receiving cytotoxic chemotherapy against tumor cells, amenorrhea may occur do to ovarian failure.

Iron deficiency and iron deficiency anemia are common nutritional and hematologic disorder in worldwide. It effects on particularly women of reproductive age. Iron deficiency is the state in which the content of iron in the body is less than normal. Iron deficiency anemia in women is one of the most important problem of health and effect on learning ability, reduced work capacity, cardiovascular disorder, premature labor, low birth weight, increased mortality in mother and infant, and increased morbidity from infection and cardiovascular disorder. Our aim of this study was to screening of iron deficiency anemia in women of reproductive age (15-45 years) in primary phases and to determine effective factors of iron deficiency anemia such as parity, abortion, menses, gastrointestinal bleeding and parasitical contamination and socioeconomic status in Tonekabon & Ramsar.Methods & Materials: This is a descriptive-crossectional study on 1026 women (15-45Y).our statical population involves the patients who had been visited in ramsar&tonekabon hematologic clinics. The β-thalassemic major and patients refer for chemotherapy excluded from study. We applied spss ver10 software and statistical tests such as chi- square. Results showed that among1026 cases evaluated in this study, prevalence of iron depleted and iron deficiency anemia was 15.1%, 21.3% respectively. Overall 36.4% of patients were in one of the stages of IDA and IRON DEFICIENCY, that there is significant association between abortion (p=0.008), menses status (P<0.0001), parasitical contamination (p=0.01) and α-thalassemia (p<0/0001) with IDA. But there was no significant association between number of parity, number of gestation, kind of delivery, gastrointestinal bleeding, age, lived location, income, occupation and socioeconomic status and IDA. Notice to prevalence of iron deficiency anemia in this study (21.3%), it is necessary the women of reproductive age, if clinical manifestations or laboratory manifestations suspect to iron deficiency anemia, Ferritin, TIBC and reticolocite are ordered and on the basis of diagnosis, it is treated.