Diagnostic Accuracy of CT Scan for Detection of Cervical Lymph Node Metastasis in Oral Squamous Cell Carcinoma in Comparison with Histopathological Analysis After Neck Dissection

Objectives: Presence/absence of cervical lymph node metastasis plays a critical role in prognosis and survival of patients with oral squamous cell carcinoma (SCC). This study was designed to assess the diagnostic accuracy of computed tomography (CT) scan for detection of cervical lymph node metastasis in oral SCC in comparison with histopathological analysis after neck dissection.Methods: In this retrospective cross-sectional study, pathology and CT reports of 50 patients with oral SCC were retrieved from the archives of Taleghani and Shariati Hospitals and data regarding the site of involvement, lymph node metastasis, level of cervical involvement and size of involved lymph node were retrieved from patient files. The results of CT scan and pathology reports were compared and the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT scan were calculated compared to the gold standard (pathology report). Basic statistics was meed for analyz the data.Results: The sensitivity of CT scan for detection of metastatic cervical lymph nodes was 69.23% compared to the pathology report (gold standard). The specificity, PPV and NPV were 27.02%, 25% and 71.42%, respectively. The diagnostic accuracy of CT scan was 38%.Conclusion: Based on the results, CT scan is not reliable for detection of metastatic cervical lymph nodes in oral SCC, and more advanced techniques may be indicated for assessment of cervical lymph node involvement and deciding on the most efficient surgical approach in patients with oral SCC

Rosai Dorfman Disease in Mandible: A Rare Case Report

Rosai Dorfman disease is generally defined as a massive bilateral painless cervical lymphadenopathy accompanied with both fever and leukocytosis with neutrophilia. Additionally, it may possibly be associated with polyclonal hypergammaglobulinemia, reversal of CD4/CD8 ratio, the elevated erythrocyte sedimentation rate (ESR), microcytic anemia, and thrombocytosis. Rosai-Dorfman disease is known as a benign self-limiting disease, so no treatment is required in many cases, although it causes death in some cases by involving vital organs like kidney. The treatment is required when there is a life-threatening situation such as airway obstruction or involvement of vital organs such as kidney, liver, and lower respiratory tract. The required treatment choices include steroid therapy, chemotherapy, radiotherapy, and surgery. Surgical treatment is performed for bulk removal to resolve the obstruction caused by the mass as well as taking biopsy for the definite histopathologic diagnosis of disease. A 26-year-old man was referred to oral and maxillofacial surgery (OMFS) clinic of Taleghani hospital with chief complaints of pain and swelling of left submandibular space. According to the patient himself, the swelling had been started three months earlier. After rejecting dental source of the lesion, we decided to remove the mass by excisional biopsy concerning the patient’s discomfort. Histopathology report verified Rosai Dorfman disease as definite diagnosis of the mass

Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Objectives The present study was aimed to identify the preoperative, intraoperative, and postoperative predictors of AF in a pure cohort of the patients with coronary artery disease who underwent CABG surgery. Methods Between November 2005 and May 2006, 302 consecutive patients were included in this prospective study. All the relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in the included patients and they were also monitored for development of post-CABG AF.Results Postoperative AF occurred in 46 (15%) of patients. By univariate analysis, older age, P-wave abnormality in ECG, presence of mitral regurgitation, larger left atrium (LA), left main coronary artery involvement, failure to graft right coronary artery (RCA), and adrenergic use in ICU were significantly associated with occurrence of post-CABG AF (all P< 0.05). However, in the logistic regression model, age (OR: 1.067, 95%CI: 1.02-1.116, P=0.005), LA dimension (OR: 1.102, 95%CI: 1.017-1.1936, P=0.017), P-wave morphology (OR: 12.07, 95%CI: 3.35-48.22, P=0.0001), failure to graft RCA (OR: 3.57, 95%CI: 1.20-10.64, P=0.022), and postoperative adrenergic use (OR: 0.35, 95%CI: 0.13-0.93, P=0.036) remained independently predictive of postoperative AF.Conclusion The present study suggested that age, P-wave morphology, LA dimension, failure to graft right coronary artery, and postoperative adrenergic use were independent predictors of post-CABG AF. Therefore, clinical data, ECG and echocardiography may be useful in preoperative risk stratification of the surgical patients for the occurrence of post-CABG A

Reconstruction of Ramus-Condyle Unit with Two Rib Grafts: Report of a Case

Introduction: Ramus-condyle unit (RCU) reconstruction is one of most challenging procedures in maxillofacial surgery. Autologous graft, custom made prosthesis and transport disc distraction are some treatment options. Case Report: In this study, we reported a mandibular DF in a 9-year-old child with condylar involvement. Our treatment plan was segmental resection and reconstructed RCU with 2 rib grafts. Results: After one year of follow-up, there is no evidence of recurrence. Mandible has symmetrical appearance and normal centric and eccentric movement. Conclusion: Rib graft is recommended for RCU reconstruction, especially in children in the growing stage

Effect of PRECEDE educational model on depression and quality of life of patients with coronary artery bypass graft surgery

&nbsp;&nbsp; BACKGROUND: This study was conducted to evaluate the effect of an educational intervention on depression and quality of life (QoL) of patients with coronary artery bypass grafting (CABG) surgery. &nbsp;&nbsp; METHODS: This was a quasi-experimental study on 54 patients after CABG who were randomly divided into the test and control groups. To evaluate depression, Cardiac Depression Scale was used. Then a researcher-made questionnaire of Predisposing, Reinforcing, Enabling Causes in Educational Diagnosis and Evaluation (PROCEED) was used and finally the 36-item Short-Form Health Survey (SF-36) was employed. The intervention was done through 9 educational sessions, once a week, lasting 60-90 minutes based on PRECEDE model and it was followed-up for two months. &nbsp;&nbsp; RESULTS: After the educational intervention, the mean score of predisposing causes, enabling causes, reinforcing causes and self-care behaviors significantly increased in the test group compared to the control group (P &lt; 0.001). There was a significant difference in mean score of depression between the two groups after the educational intervention (P &lt; 0.001). In addition, there was a significant difference after the intervention in physical functioning (P = 0.04), mental problems related to QoL (P &lt; 0.001) and generally, in psychological health (P = 0.04). &nbsp;&nbsp; CONCLUSION: The findings of this study confirmed the efficacy of PRECEDE educational model and its components (predisposing, enabling and reinforcing causes) and behavioral factors of it on improvement of psychological status and depression of the patients which finally increased QoL of patients after CABG. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Educational Intervention, Depression, Quality of Life, PRECEDE Model.</p