gholamali godazandeh

Gallstones are caused by the accumulation and high density of fat-soluble substances inside the gallbladder. Cichorium intybus and Artemisia absinthium have phenol and flavonoid compounds and are believed to have a potential effect on solubility of gallstones. Therefore, the present study was conducted to investigate the effect of the extracts of Cichorium intybus root and Artemisia absinthium aerial part in solubility of gallstones.

In this experimental study, gallstones were collected from Sari Shafa Hospital and the stone compounds were identified by UV and DSC. The gallstones were then cut into equal size and weight (200 mg). Acidic, alkaline, and distilled water media were prepared as control groups along with the experimental groups which contained Cichorium and Artemisia extracts at 1 mg/ml, 10 mg/ml, and 100 mg/ml, 500 mg/ml, respectively. A gallstone sample was placed in each media and the dissolution rate of the stone compounds was measured by an auto-analyzer after 24 and 48 hours.

The UV spectrum showed the presence of bilirubin in the gallstones and the DSC thermogram showed the presence of cholesterol in the stones. Examination of isolated gallstone compounds showed that Cichorium extract at 500 mg could dissolve 75% of triglycerides (P<0.001) and the Artemisia extract at 500 mg could dissolve 63% of cholesterol which were significantly different compared to control groups (P<0.01).

According to current study, Cichorium and Artemisia have a significant effect on the dissolution of gallstones.

Background and Importance: 

Diffuse idiopathic skeletal hyperostosis (DISH) can compress the trachea and esophagus when located in the cervical spine. In this report, we investigated whether it is preferable to perform the early surgical intervention in symptomatic patients or to wait and administer supportive care and perform late surgical intervention regardless of whether symptoms progress or not.

We present the case of a 70-year-old patient with diffuse idiopathic skeletal hyperostosis (DISH) causing significant dysphagia and unilateral vocal cord paresis, resulting in dyspnea and stridor. Imaging diagnostics revealed large osteophytes anterior to the cervical spine from C3 to C6 compressing the cervical spine. Significant clinical improvement was observed following the anterior resection of the patient's osteophytes.

In order to achieve higher success and less recurrence, it is preferable to perform surgical intervention earlier in the disease's progression. However, more studies are necessary to confirm this because most of the present results are from case report articles and have less evidence.

According to previous studies, using the frozen section procedure during breast surgery reduces the rate of error and the need for re-surgery. We aimed at performing a comprehensive systematic review and meta-analysis to provide reliable evidence on the diagnostic value of frozen section procedures in breast-conserving surgery (BCS).

A thorough search was performed in PubMed, Embase, Cochrane Library, and Web of Science databases for human diagnostic studies that used the frozen section in BCS. Meta-analyses were done to find the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

Human diagnostic studies used the frozen section in breast-conserving surgery and studies that reported the sensitivity and specificity of the frozen section in BCS or contained data that could be calculated the desired parameters were selected for this meta-analysis.

Assessment of studies quality was done and data was extracted from included papers. Then, the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of included papers.

Thirty-five papers were entered into our study. The meta-analysis indicated the high sensitivity (83.47, 95%CI 79.61 - 87.32) and specificity (99.29, 95%CI 98.89 - 99.68) for the frozen section in BCS, which resulted in an accuracy of 93.77 (95%CI 92.45 - 95.10). We also found a significant PPV (93.26, 95%CI 91.25 - 95.27), NPV (92.17, 95%CI 90.22 - 94.11), PLR (7.99, 95%CI 6.01 - 9.96), and NLR (0.18, 95%CI 0.14 - 0.23).

The findings showed that intraoperative frozen section analysis has high sensitivity and specificity for evaluating lumpectomy margins in patients with early-stage breast cancer and significantly reduces the need for re-operation. Accordingly, re-operation costs are not imposed on the patient and reduce the anxiety of the patients.

Disease registry of Coronavirus disease 2019 (COVID-19) as an emerging global health threat could create a suitable research context, identify various aspects of the disease from symptoms to laboratory diagnoses, and determine effectiveness of treatment. The present study aimed to design and implement COVID-19 registry in Sari Imam Khomeini Hospital and investigated preliminary results.

At first stage, to design the disease registry, a strategy committee was established consisting of experts involved in COVID-19. Variables determined by members of the registry strategy committee included demographic findings, patients’ vital signs, comorbidity, laboratory findings, diagnostic test results, disease forms, complications, patients’ prognosis, and medical interventions on admission and at the time of discharge. Then, a web based software was designed in Structured Query Language (SQL) to record the information. The study population included all patients attending Sari Imam Khomeini Hospital with clinical and molecular diagnosis of COVID-19.

Out of 1924 registered patients, 829 (43.1%) were female. The mean age of patients was 53.2±17.5 years. The mean ages of men and women were 53.9±16.8 and 52.7±18.1 years, respectively (P= 0.142).

Outbreak of COVID-19 and paucity of information about the disease call for an accurate, complete, and reliable database including timely information which could be achieved by an integrated disease registry.

Lung involvement is highly important in patients with Coronavirus disease 2019 (COVID-19) and CT scan plays a major role in diagnosis and treatment of patients. This study investigated a large sample size of COVID-19 patients who performed CT scan.

This descriptive cross-sectional study was done using the CT scan findings of all suspected, probable, and definite patients of COVID-19 attending Sari Shafa Hospital, Iran during March and April 2020. The Siemens Somatom Emotion 16-slice CT scanner was used. CT scan was performed by HRCT method only in axial sections without contrast material and with 2 mm thickness sections. Data, including demographic information and HRCT findings were collected from the picture archiving and communication system (PACS).

From 3132 patients, 1883 (60.1%) were found with no positive results. Among those with lung involvement, 1138 (36.4%) had highly suggestive symptoms of COVID-19 and 111 (3.5%) had inconsistent symptoms. Bilateral, peripheral, and diffuse lung involvement were seen in 79.9%, 53.3%, and 87.6%, respectively. Patchy morphology was detected in 64.9%. Ground-glass opacities were seen in 96.7% and pleural effusion was observed in 6.4%. The highest frequency involvement was in the lower right lobe (82%) and 697 patients with positive findings had less than 25% lung involvement.

The present study showed ground-glass opacity as the most common finding of the CT scan in patients with COVID-19 and bilateral lung involvement that occurred mainly in lower lobes.

Background and purpose Pulmonary arteriovenous malformations (PAVM) are lung lesions that affect most of the periphery of the lower lobes, and are manifested by dyspnea, hemoptysis, and hemothorax. Pregnancy is one of the conditions in which these malformations appear due to hemodynamic changes and hormonal factors such as increased levels of estrogen. This paper presents the case of a pregnant woman at 28 weeks of gestation who received first-aid treatment for symptoms of respiratory distress and hemothorax. Then, she was transferred to the operating room and thoracotomy was performed and the vascular lesion was resected. After that, the patient had stable hemodynamic conditions and was transferred to the ward. Our patient was eligible for thoracotomy due to pulmonary manifestations of the disease. In dealing with these situations, immediate counseling and collaboration of gynecologists with thoracic surgeons can save the lives of mother and her fetus.

Hydatid disease (HD) is an infectious disease caused by echinococcosis. Hydatid cyst (HC) most commonly invades the liver (60-70%) and the lungs (20-25%). However, other parts of the body and even unusual locations can be infected, mimicking a benign lesion that could be easily missed. Primary HC of the chest wall is extremely rare, even in countries where echinococcosis is endemic. We herein present a case of a 40-year-old man with a right-sided growing thoracic wall mass. The patient did not present the relevant history (living in rural areas or being in contact with farm animals) and the serological examination with the indirect hemagglutination test was negative. During surgery, a cystic mass between the eleventh and twelfth ribs was observed. The thoracic wall mass extended to the posterior abdominal wall and was entirely extrapulmonary and extraperitoneal. All cystic structures of the thoracic wall and intrathoracic region were removed, and the primary defect was reconstructed. In endemic areas such as Iran, HD should be considered in the differential diagnosis of mass lesions located in the chest wall or other parts of the body, even without the relevant history or serologic evidence.

The relationship between obesity and the risk of breast cancer has been highlighted in some studies. This research aimed at studying the association between anthropometric indices and breast cancer based on enrolment phase (cross-sectional phase) data in Tabari cohort study. In this cohort, 51 cases of breast cancer were recorded which were considered as the case group. Also, 153 individuals (without any type of cancer) from Tabari cohort population were randomly selected as control group. Data analysis was performed applying independent t-test, chi-square, and multivariate logistic regression. The frequency of waist circumference ≥88 cm in case group was slightly lower than that of the control group (74.5% vs. 75.2%, P= 0.926). In case group, the frequency of waist to hip ratio (less than 0.85) was lower than that of the control group (70.6% vs. 80.4%, P= 0.144). The risk of breast cancer was found to be higher in rural population (OR: 8.28, P<0.001) and in women with higher education (OR: 0.06, P<0.001). This study did not confirm the association between anthropometric indices and breast cancer.

Breast cancer is the most common cancer in women. Most recently C3435T polymorphism of MDR1 gene is considered as one of the major causes of drug resistance in treatment of this disease. This study was conducted to investigate the relationship between C3435T MDR1 gene polymorphism and treatment response in breast cancer patients. In this longitudinal study, blood samples were collected from all cases and gene polymorphism was performed by PCR-RFLP method. Then, all patients underwent chemotherapy and patient response to treatment was evaluated. They were divided into two categories according to clinical response to treatment and lack of treatment response. This research included 152 women (mean age: 49.84±10.95 years) with breast cancer. The genotype found more frequently was CT (49.2%). Among the patients, 74.3% responded to treatments and in 25.7% there was no response to treatment. We found no significant differences between different genotypes in response to treatment (P=0.485). There was no direct relationship between the response of breast cancer to treatment and C3435T polymorphism of MDR1 gene.

Background and Sternal Wound Infection (SWI) is a serious complication of median sternotomy that increases the rate of mortality. We report our experience of managing SWI in a regional cardiothoracic unit in Mazandaran province, Iran.
We prospectively studied 4725 patients who underwent isolated coronary artery bypass grafting between March 2012 and March 2015. Information about age, sex, morbidities, surgical factors and nature of sternal wound infection were recorded. Treatment options were stratified by nature of infection, and timing and nature of management. Data analysis was done using Med calc soft ware and p-values less than 0.5 were considered significant.
Sternal wound infection occurred in 49 (1%) patients. There were 26 (0.55%) superficial and 23 (0.48%) deep SWIs. SWI patients were found to be mainly females, with diabetes or hypertension, high body mass indices and longer aortic cross-clamp time. All patients with superficial SWI were managed by skin debridement and closure. Patients with deep SWI who had surgery within 48 hours of diagnosis were managed using skin and bone debridement and sternal rewiring following mediastinal drain. The mortality rate was found to be high in patients with SWI (12.2%).
Low sternal wound infection can be achieved with an ongoing focus on appropriate infection control. SWI significantly increases the risk of mortality which could be reduced through early intervention.

Hypocalcemia is a well-recognized complication after total thyroidectomy. Hypovitaminosis D may have additional effect in the development of hypocalcemia. This study aimed to determine the effect of total thyroidectomy on postoperative serum calcium in patients with and without hypovitaminosis D. This prospective study was performed on patients who underwent total thyroidectomy from 2011 to 2014 in Imam Khomeini General Hospital of Mazandaran University of Medical Sciences. Serum calcium and vitamin D values were recorded before and after surgery. The patients were classified according to serum vitamin D concentrations as less 10 ng/ml (vitamin D deficiency) or higher (control group). The mean values of postoperative calcium level for each class of serum vitamin D were determined and compared. Hypocalcemia was defined as a postoperative calcium level <8 mg/dl. 125 patients due to thyroid disease underwent total thyroidectomy. The incidence of symptomatic and asymptomatic hypocalcemia after surgery was 12% (n=15) and 3.2% (n=4) respectively. 82 (65.6%) patients had vitamin D deficiency and 43 (34.4%) patients had sufficient vitamin D level. There was not any significant difference in calcium level (8.67±0.58 mg/dl vs. 8.70±0.59 mg/dl) between two vitamin D studied groups after thyroid surgery (p>0.05). The findings of this study indicated that vitamin D deficiency had no significant effect on post-thyroidectomy serum calcium level.

We report the cases of two patients diagnosed with Morgagni hernia who presented with nonspecific abdominal symptoms. Both underwent laparo­scopic surgery that used a dual-sided mesh, polyvinylidene fluoride (PVDF; Dynamesh IPOM®). The procedures were successful and both patients were discharged with no complications. There was no recurrence in 18 months of follow up.Herein is the report of these cases and a literature review.

Background and Âlthough some studies have demonstrated the effect of magnesium sulphate on reducing the postoperative pain, some others have refuted this and showed that it has limited or no effect. Ïn this study, the researchers investigated the effects of pre- and intraoperative magnesium sulphate administration on the postoperative pain and opioid consumption. Ïn a randomized double blind clinical trial with using placebo in the control group, thirty-two patients with the age range of 15-74 undergoing inguinal surgery in Ïmam Khomeini Hospital in Sari were nonrandomly divided into two equal groups. The patients in the magnesium sulphate group received magnesium sulphate 50 mg/kg/h ÏV, 15 minutes before until one hour during the surgery, whereas patients in the control group received the same volume of normal saline 20cc (infusion with similar volume) over the same time. The data were analyzed using SPSS version 16.. Postoperative pain was significantly lower in magnesium sulphate group in comparison to control group. Ât 2, 6, 12 and 24 hrs after the operation, the mean VÂS for control and case groups were 8.50± 0.894, 7.06± 1.94, (P=0.012), 8.31± 1.07, 6.63± 1.360 (P=0.001), 8.06± 1.124, 4.75±1.125 (P=0.001), 7.31±1.45, 4.06±0.85 (P=0.001), 6.69±1.40, 0.63±1.02 (P=0.001), respectively. Çonclusion: Ïntraoperative magnesium sulphate infusion in inguinal surgery considerably decreases postoperative pain in the first 24 hours after operation.

Background and Nowadays، studies on localizing hyperparathyroidism suggest a replacement of bilateral neck surgery of parathyroid with unilateral exploration. The purpose of this study was to survey the simultaneous use of Ültrasonography (ÜS) and 99TÇMSS to localize the hyper function of parathyroid gland preoperatively. Â descriptive، retrospective case-series study was carried out on 25 patients with hyperparathyroidism whose parathyroid adenomas localized by ÜS or 99TÇMSS and underwent surgery between 1999 and 2009. This study involves a retrospective collection of demographic، biochemical and imaging data as well as pathologic and surgical information. The results of imaging studies were compared with surgical and histological findings. The sensitivity of ÜS and SS were higher for adenomas (53% and 83%) than hyperplastic glands (50% and 66%). The sensitivity and PPV in simultaneous use of ÜS and SS to localize single adenoma were 84% and 100%، respectively. Çonclusion: Since even one parathyroid lesion was not solely identified using ÜS، there was not a statistically significant difference on the sensitivity of scintigraphy between 99TÇMSS and simultaneous use of ÜS and 99TÇMSS (P<0. 05). Therefore، 99TÇMSS is recommended if parathyroid localization prior to unilateral surgery is required.