فهرست مطالب elyas mostafapour

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.

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.

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%.

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.

Laryngeal adenoid cystic carcinoma (LACC) is a very rare cancer among laryngopharyngeal malignancies with varieties in presentation.
Here, we discuss a case of 54-year-old female who was admitted in the emergency department with long-term dyspnea, hoarseness, and stridor. Cervicothoracic multi detector computed tomography (MDCT) scan showed a mass in the laryngeal area and the pathology reported adenoid cystic carcinoma in the biopsy. Total laryngectomy and partial pharyngectomy was taken into action. The adjuvant radiotherapy was performed too.
Although adenoid cystic carcinoma is rare, it is advised to use both CT-scan and deep biopsy to make definite diagnosis. Surgical excision is necessary and follow up is advised, although surgical excision of this tumor is extremely challenging case by case.

Prospective studies evaluating outcome of laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia are less in Asian people.
This study conducted to evaluate the results of laparoscopic cardiomyotomy and partial fundoplication for achalasia.
Patients and Thirty patients who underwent Heller myotomy for achalasia via laparoscopy in Alzahra hospital Isfahan, Iran were recorded prospectively (2009 - 2013). Median follow-up was 18 months. Symptoms including dysphagia, regurgitation, chest pain and weight loss were recorded before and after operation. Also, previous treatment for achalasia such as endoscopic pneumatic dilatations and intrasphincteric injection of botulinum toxin or other component, duration of symptoms and duration and complication of operation was recorded.
Among 30 patients, there were 13 (43.3%) females and 17 (56.7%) males, and mean age was 40.8 years (range, 20 - 68 years). The operations were finished laparoscopically in all patients. Mean operative time was 137 ± 36.2 minutes. The patients were symptomatic for at least 30 months before referring for surgery. There are some difficulties in dissection in cases who received Ethanolamine or Botholinum Toxin injection as non-surgical treatment before that. Mean hospital stay was 2.45 days. Regurgitation, chest pain and heartburn relieved significantly in median follow up of 18 months, in 100%, 66.6% and 70%, respectively (P Our study showed that laparascopic Helermyotomy with Dor fundoplication result in significant relief of dysphagia. Overall clinical symptoms indicate improvement in patient functional status during 18-month follow-up.

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 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. 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 1st year, 41% at 3rd year and 10% at 5th 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). 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.

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.. 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.. 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).. 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..

Blood glucose controlling is a major issue in diabetes management. Many fluctuations in blood glucose level make the close controlling of glucose by physicians as one of the most important principles in diabetic patients managing. The case was a 58 y/o man with a history of 14 years old diabetes under insulin therapy. After informed consult and description about using the device the instrument was given to him. The patient used the device 30 times in a week and we all received SMS of the recorded blood glucose information. For constructing the device first، printed circuit board (PCB) was designed and then electronic components (such as mobile board، micro controller and glucometer) and CNC work on the place were marked on the PCB. The installation and application were stored within the micro controller by a programmer. After pushing a button the needle of glucometer enters the skin. Data was sent through GSM (Global System for Mobile Communication) by a SIM card to the physician and 5 relatives of patients and also was shown on a LED monitor implanted on electronic board. This new device helps physicians to control patients’ glucose closely without any admitting and extra cost. Also using this device will decrease the rate of complicated hypoglycemic and hyperglycemic attacks.

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 β2 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. 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 40 mg 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. 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. 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.

Hypertension is a common chronic disease with increasing prevalence worldwide. Regular close monitoring of blood pressure is key point of hypertension management. Home monitoring of blood pressure has its own problems such as lack of early access to a physician in case of emergency. In this study we have designed a device that could send the patient’s self-measured blood pressure to physician. Case report: A 56 year old woman with a 6 year history of hypertension was enrolled to the study. After giving information about using the device، we gave it to her. With each use of device at home we received an SMS (Short Message Service) on patient’s blood pressure that were coordinated with self-recorded blood pressures. This device consisted of a designed electronic board and installed components (such as programmed mobile board and micro controller) placed on the board and attached to a blood pressure measuring device. After pushing a button، the blood pressure was measured spontaneously and data shown on an LED monitor and sent through GSM (Global System for Mobile Communication) by a sim card to the physician. This new device helps physicians to control patients’ blood pressure closely without any extra cost. Also using this device will decrease the rate of complicated hypertensive attacks.

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. 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. 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) 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

One of the important etiologies for cryptogenic stroke is paradoxical embolization secondary to Patent Foramen Ovale (PFO). Foramen ovale can secondarily reopen due to Pulmonary Arterial Hypertension (PAH) which is common among the older age. PAH is known as a frequent and life threatening complication of COPD. The aim of this study was to determine the prevalence of PFO between COPD patients with PAH and compare it with the ratio of PFO in non PAH COPD patients by Valsalva Maneuver (VM) following the TCD test.
This study was performed on 55 patients with COPD exacerbation who were admitted to Rasul-Akram Hospital in Tehran, Iran. The patients with high PAH were considered as the case group and the others without PAH were the control group. All patients underwent Trascranial Doppler (TCD) to detect intracardiac right-to-left shunt (RLS) related by PFO. The data were collected and analyzed.
In the case group, among 45 patients 25 (55.5%) males and 20 (44.5%) females] with the mean age of 64.68±10.73 years, 31 (68.8%) subjects had PFO. In 10 control patients whose PAP were normal during TTE, we detected PFO in 2 (20%) patients during VM (p<0.001). There was a significant correlation with the number of microembolic signals (MES) and the increase in PAP (p=0.019).
Right to left shunting was significantly more frequent in COPD patients with high PAP. High pulmonary pressure had a cardinal role in increasing the prevalence of RLS among these patients.