Cerebral Protection During Coronary Artery Bypasses Grafting in Bilateral Total Internal Carotids Occlusion: Case Report

Introduction: The best management for the patient with coronary artery disease (CAD) that requires emergent coronary bypass graft surgery (CABG) with bilateral total internal carotid artery occlusions previously reported. Here we report two successful cases of CABG with additional occlusion in the circle of Willis anterior or posterior communicating artery “incomplete cow” with onpump technique and cerebral protection considerations. Case Presentation: Bilateral carotid artery occlusion, coronary artery disease, and emergency operation with cardiopulmonary bypass are associated with increased stroke, especially when there is one additional occlusion of the cerebral artery in the circle of Willis. Routine preoperative carotid artery sonography and selective carotid angiography revealed bilateral total carotid occlusion in both cases in addition, CT-angiography also confirmed occlusions of right posterior communicating in the first case and left posterior communicating artery in the second case. Collateral circulation feeding in the intracranial circulations originated mainly from the vertebrobasilar system (compensatory phase) preoperative physical examinations showed no neurological deficit. Operation was done successfully with moderate hypothermia and different cerebral protection considerations and postoperative courses were uneventful and patients discharged from hospital seven days post operation. Conclusions: Anesthesia should consider hemodynamic management and avoid significant tachycardia or bradycardia and severe hypertension or hypotension

Quality of life in patients with gastric cancer: translation and psychometric evaluation of the Iranian version of EORTC QLQ-STO22

<p>Abstract</p> <p>Background</p> <p>Disease and treatment related events, can adversely affect the quality of life of patients with cancer. The purpose of this study was to translate and validate a gastric cancer specific health related quality of life questionnaire (EORTC QLQ-STO22) for Iranian patients suffering from gastric cancer.</p> <p>Methods</p> <p>Forward-backward procedure was applied to translate the English language version of the EORTC QLQ-STO22 into Persian (Iranian language). Then, the questionnaire and the EORTC core quality of life instrument (QLQ-C30) were administered to a sample of patients with confirmed diagnosis of gastric cancer. All patients filled in questionnaires before and after one month of treatment. Patients were divided into two groups based on intension of treatment (curative vs. palliative). Reliability and validity of the module was tested by internal consistency and known group comparisons, respectively.</p> <p>Results</p> <p>In all, 105 patients were entered into the study. Cronbach's alpha for multi-item scales (to test reliability) ranged from 0.54 to 0.87. The questionnaire discriminated well between clinically distinct subgroups of patients both before and after treatment lending support to its convergent and clinical validity.</p> <p>Conclusion</p> <p>Overall, the Iranian version of the EORTC QLQ-STO22 demonstrated a good reliability and clinical validity to support its use in combination with core questionnaire in outcome studies of gastric cancer in Iran. However, using the QLQ-STO22 in a wide range of Iranian patients with gastric cancer should allow further confirmation for its psychometric properties.</p

Lead Toxicity: A Probable Cause of Abdominal Pain in Drug Abusers

Background: Lead toxicity is caused by ingestion, inhalation, or contact with particles or vapors containing lead. It can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. In this study, we have tried to find a relationship between lead poisoning and drug abuse.Methods: In a cross sectional study, drug addicts presenting with abdominal pain referring to GI center ofImam Khomeini hospital in 2008 were observed. Patients having occupational contact with lead were excluded from the study. Required data included age, sex, clinical findings, Para clinic results and blood lead level. Results were analyzed through SPSS-15 software.Results: 42 patients (all male) with average age of 46.9 ± 10.1 years were included in the study. Averageblood lead level was 51.17±27.96µg/dl. 22 patients (52.6%) had lead toxicity. A significant relation was found between lead toxicity and mode of opium drug use; however relation between lead toxicity and duration of addiction was not significant. Similarly, a meaningful relation was found between lead toxicity and abnormal liver function test, urine tests, ECG, presence of basophilic stippling and hyperuricemia.Conclusion: There seems to be a significant relation between opium drug abuse and lead toxicity. Further studies with more cases and ethnicities are needed

Gastric Cancer in People Bbelow and Above 40; Is It Different?

Background:Gastric cancer is the second most common cancer and also the second cancer related death all over the world. In recent years recorded data for tumor   has shown a rise in the incidence of gastric cancer in young individuals. The present study was designed to compare some of the epidemiologic characteristics of individuals suffering from gastric cancer aged below and above forty years.   Methods: This cross-sectional study was performed on 389 patients suffering from gastric cancer referred to a referral private clinic in Tehran during the years 1991 and 2001. The patients were divided into two groups, those older than 40 years and the younger ones. The demographic information, the tumor type and location as well as the prevalence of the H. pylori infection was compared in the two groups. The collected data were entered in SPSS version 13 and analyzed using chi-square and fisher exact test. Results: Fifty patients (12.9%) were reported to be lower than 40 years. The mean   age of the patients in this group was 32.1±6.8years while the number was calculated   to be 63.23 ± 9.7 years in the other group. The male to female ratio in the group   younger and older than 40 years was 1.9: 1 and 2.6:1, respectively. Adenocarcinama   and lymphoma compromised 70% and 12% of the individuals younger than 40 years   whereas they were reported in 89.3% and 3.2% of the patients in the other group.While cancer in the middle third of stomach was the most frequent type in both groups,the prevalence of upper third gastric cancer was considerably higher in those younger than 40 years old (19.9% vs. 5%).H. pylori infection was seen in 23.2% of the younger group, while more than 56% of the older group suffered from H. pylori infection. There was a statistically significant difference between the two groups(P<0.017). Conclusion: gastric cancer is not rare among the individuals younger than 40 years old. The disease is reported to be seen in the absence of H. pylori infection in the majority of these cases. There is a considerable difference between the prevalence of malignant lymphoma in this group of patients compared with the older patient

Gallstone Ileus and A Three Centimeters Stone In Terminal Ileum: A Case Rreport

Gallstone ileus is a rare complication of cholelithiasis found in less than 0.5% of   patients. It is an uncommon cause of small bowel obstruction,accounting for 1% to 3% of all mechanical bowel obstructions and over 25% of nonstrangulated bowel obstructions in patients older than 65 years with a female predominance.We report a 60-year-old woman who was referred to our hospital because of abdominal pain, nausea,vomiting and constipation forty days prior to admission.An upright abdominal X-ray showed air fluid levels and an oval calcified opacity in the region of right iliac fossa. The ultrasonographic examination revealed air in billiary  tree and several small stones in the gallbladder. Follow up of abdominopelvic CT scan showed severe distention of small intestinal loops, pneumobilia and a 3cm-calcified  intraluminal mass. The clinical diagnosis of gallstone illeus was made, but unfortunately her general condition worsened with the decline in Glasgow Coma Scale   declined since she was suffered an extensive cerebrovascular accident and eventually she died of cardiac arrest. Inspired by the mentioned case we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus

Intrabiliaryrupture of Hydatid Cyst in a Patient With Cirrhosis

Acase of 48-year-old male, hepatitis B cirrhosis, hepatic hydatid cyst,jaundice,fever,chills suffered from severe abdominal pain in the right upper quadrant. He was suffered from acute cholangitis and spontaneous bacterial peritonitis, and received intravenous antibiotics but his condition rapidly deteriorated to sepsis and severe hepatic failure.The presence of dilated Common Bile Duct (CBD) containing small cystic lesions suggesting daughter cysts on ultrasonography, which was further verified by Endoscopic Retrograde Cholangiopancreatography (ERCP), along with significant   eosinophilia and positive serology test for hydatid cyst, made the diagnosis of intrabiliary rupture of hydatid cyst definite. We performed a delayed endoscopic  sphincterotomy which resulted in complete resolution of the clinical picture. The patient   was treated with Albendazol and Lamivudin and was referred for surgery.

Effects Of Obstructive Sleep Apnea Syndrome On Serum Aminotransferase Levels And LIinsulin Resistance

Bckground:Patients with obstructive sleep apnea (OSA) are at risk of developing the fatty liver as a result of being overweight. Several studies suggest that OSA per se could be a risk factor for liver Injury;and ischemic hepatitis with OSA.The OSA is an independent risk factor for Insulin resistance. Therefore, we investigated liver enzymes and insulin resistance in patients with OSA, and compared with controls. Methods: Eighty-one consecutive patients with clinical suspicion of OSA were referred to the Sleep Unit of Masih Daneshvary hospital. On the basis of Polysomnography results patients were divided into two groups: The OSA and non-OSA cases, and also patients without OSA were used as internal controls. The Serum levels of liver enzymes were measured in all patients and abdominal ultrasound examination performed for screening the fatty liver and its grading. Insulin resistance was calculated via homeostasis model assessment(HOMA).Results:The OSA was present in 41 and absent in 40 patients.Age, sex and body mass indices were not significantly different in two groups. The mean of alanine aminotransferase (ALT) was 31.24±14.05 IU/L in OSA and 29.97±8.9 IU/L in non-OSA (p= 0.349) and aspartate aminotransferase (AST) was 29.07±9.6 IU/L in OSA and 26.85±6.7 IU/L in non-OSA (p= 0.389). The mean of HOMA was 2.05±18.2 in OSA and 1.5±0.54 in non-OSA(p&lt; 0.001). Conclusion: This study shows that OSA, independent of overweight conditions, is not a risk factor for abnormal liver enzymes.However,the OSA per se seems to be associated with increase in insulin resistance and severity of fatty liver

Frequency of YMDD Mutations in Patients with Chronic Hepatitis B Untreated with Antiviral Medicines

Background: Investigators were suspicious of tyrosine-methionine-aspartate-aspartate (YMDD) mutations occurred only in patients who were treated by lamivudine. However, YMDD mutations of hepatitis B virus gene (HBV DNA) in patients with chronic hepatitis B (CHB) untreated with antiviral medicines was reported in some studies. The aim of this study was to evaluate YMDD mutations in Iranian Patients with chronic hepatitis B (CHB) untreated with antiviral medicines. Methods: In a cross sectional study, 151 adult patients with positive Hepatitis B surface antigen (HBsAg) (78 asymptomatic hepatitis B virus carriers, 73 active chronic hepatitis B patients or cirrhosis patients) were evaluated for YMDD mutants. The patients who were treated with interferon and Lamivudine or Adfovier in one year prior to the study were excluded. YMDD mutations of HBV DNA were detected by PCR-RFLP (PCR Restriction Fragment Length Polymorphism) in a single laboratory. Results: The mean (±SD) age of patients was 37±4 years. Eighty one (54%) cases were male and 70 (46%) were female. Eight cases (5.3%) out of 151 had YMDD mutations. The type of mutation in all of these patients was YSDD. There was no significant relationship between YMDD mutation and viral load and HDV Ab (p>0.05). Conclusions: The mutant strains of the YMDD motif of HBV polymerase can be found in some patients without lamivudine treatment. However, in view of rather clinically insignificant YMDD mutation frequency, routine testing for YMDD mutations prior to antiviral therapy is not recommended in these patients