Investigating the health of resection margins for conducting intra operative radiotherapy during breast conservative surgery

To conduct radiotherapy during operation in treating the breast cancer through breast conservative surgery method, we must ensure the healthiness of resection margins during the operation. Then, electron ray is flashed to the surrounding tissues in order to reduce the chance of the presence of any microscopic cancer cells. The present research studies the ability of Frozen in diagnosing the health or involvement of margins during the operation and seeks to compare the results of Frozen with the results of gold standard (permanent pathology) diagnostic method in patients suffering from breast cancer who have undergone breast conservative surgery and Intra-operative radiotherapy. In this observational study conducted in the form of a retrospective research, some 496 patients suffering from breast cancer who have undergone breast conservative surgery were selected through the convenience sampling method and the results of breast margin pathologies conducted through Permanent and Frozen section were compared against one another so that we may find the sensitivities and specifications of the Frozen sections in comparison with the Permanent method. In the Frozen and Permanent methods, the margins had a freedom degree of 83.1 and 98 respectively. The sensitivity and peculiarity of the Frozen section as compared to the Permanent method were 80 and 84 respectively, however the negative predictive value was 99.5. A significant relationship was observed here based on chi square test. The level of accuracy was 84.3, and the pseudo negative weas 0.5. The compliance level of the Permanent and Frozen diagnostic methods was 84.3. It is therefore concluded that the Frozen section has a good degree of compliance in determining the state of margin of the removed cancerous lump in breast conservative surgeries and false negative reports have been issued for 0.5 of the cases. Thus, it is recommended to use the Frozen section before radiotherapy to determine the freedom of margins. � 2016, Oriental Scientific Publishing Company. All rights reserved

The occurrence of giant mesenteric cyst and adrenal ganglioneuroma in a schizophrenic male patient presenting as pseudocyesis: A case report

In psychological patients like our case, somatically expressed symptoms which can imply another psychological syndrome should be dealt with cautiously. © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Lt

A comparison of bupivacaine lavage and diclofenac suppository effects on post-operative pain of laparascopic transabdominal pre-peritoneal herniorrhaphy: A randomized clinical trial study

Objectives: Injection of a topical anaesthetic has been proved to be helpful with reducing pain after laparoscopic herniorrhaphy. We aimed to assess the effect of bupivacaine lavage on postoperative pain and compare it with diclofenac suppository. In this randomized clinical trial, 60 patients - scheduled for laparoscopic herniorrhaphy - were enrolled and randomized into three groups of 20 each, including diclofenac suppository, bupivacaine lavage, and normal saline as a placebo.The patients were investigated for postoperative pain scores, vomiting, nausea, morphine request, and duration of hospitalization. Results: In the bupivacaine group, pain levels in recovery room, 4, 8 and 12 h after surgery, were significantly lower than diclofenac group; at time points of 16, 20 and 24 h after surgery, difference between two groups was not significant. Regarding vomiting and nausea, at time points of 1 and 3 h after surgery, results show no significant difference between the groups. Incident of infection, 1 h and 1 week after the surgery, was not significantly different among the groups. Duration of hospitalization in the bupivacaine group was much lower than the diclofenac group. Based on our results, use of the bupivacaine lavage can reduce postoperative pain in patients undergoing laparoscopic herniorrhaphy. Trial Registration Randomized clinical trial IRCT20180522039782N2; date of registration:14/10/2018 © 2020 The Author(s)

Traumatic Pulmonary Pneumatoceles (Pseudocyst)

Introduction: Traumatic pulmonary parenchymal cavitary lesions (TPPCs) are pulmonary pseudocysts raiding secondary to lung contusion. Method: To provide an overview of the etiology, presentation, diagnosis and treatment of TPPCs, and to discuss this in the context of a cohort of 12 retrospectively reviewed patients with TPPCs presenting to Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2014 to December 2016. Between January 2014 and December 2016, a total of twelve trauma patients presented to Sahlgrenska University Hospital with TPPC following blunt trauma. Results: TPPCs are of limited clinical consequence. Inexperienced clinicians may treat these inappropriately. A Computed Tomography (CT) scan is the investigation of choice. Treatment is symptomatic. Intervention is indicated only in case of complications

A Survey on Gastrointestinal Stromal Tumors (GISTs) Incidence in Iran: a National Population-based cancer registry Study.

Background: Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal (GI) tract which are associated with high rates of malignant transformation. The current study aims to design a survey to assess the incidence of GISTs in Iran through a multicenter population-based cancer registry study. Materials and Methods: A total of 447 GISTs patients who have been registered to Iran National Cancer Registry (INCR) between 2009 to 2014 were ordered into age strata, based on WHO guidelines. Patients were categorized into six groups by region. Tumors were classified into GI and extra GI tumors. Also, grading of tumors performed according to the International Classification of Diseases for Oncology, 3rd Revision (ICD-O). Crude incidence rate, age-standardized incidence rate (ASIR), and sex standardized incidence rate (SSIR) were calculated by using SPSS software. Results: In the current study all 447 cases of GISTs that were registered between 2009 to 2014 were included. 56.5 of them (253/447) were male, with a male to female ratio of 1.3:1. The majority of patients were found in Isfahan (17.8). 68.6 (307/447) of cases aged between 15 and 64, with the most involved age stratum being 50-55 years old (14.5). Crude incidence rate was 5.948 per 1,000,000 and age standard incidence rate (ASIR) was 7.334 per 1,000,000. The highest ASIR was 1.593 per 1,000,000 in 2012 and then it declined. The stomach was the leading location of tumors (46), followed by the small intestine (23). Conclusions The occurrence of GISTs is more common in men and the older population. As a preliminary National Population study, the rate of GISTs in the Iranian population has been declined over the study period. © 2021 Ioannina University School of Medicine. All rights reserved

Nerve Conduction Study in the Extremity Carrying Fistula in Hemodialysis Patients

Introduction: Arteriovenous fistulas (AVF) make chronic hemodialysis easy, but the complications are unpredictable. Ischemic neuropathy due to arterial insufficiency is one of the most important complications of AVF. This study was designed to evaluate ischemic neuropathy using electro diagnostic method in the extremity carrying fistula. Methods: In this cross-sectional study, 37 hemodialysis patients at the hemodialysis center of Shahid-Mohammadi hospital (Bandar-Abbas) were enrolled. All of the patients had only one AVF in one extremity. NCV of median and ulnar nerves of both upper extremities were evaluated and the intact extremity of all patients served as the control group. Results: In patients with distal AVF, ulnar motor conduction velocities were significantly increased (p: 0.034). Distal and proximal amplitudes of ulnar nerve were decreased only in non-diabetic and hypertensive patients (p<0.05). Median sensory nerve action potential was increased, distal amplitude decreased (p: 0.04) and sensory latency was increased (p: 0.02). In patients with proximal AVF, ulnar proximal amplitude and median motor conduction velocities were decreased (p: 0.05). There was a negative correlation between the age of AVF and development of neuropathy. In most patients with neuropathy, AVF age was less than one year. Conclusion: Ulnar nerve is more sensitive to ischemia than median nerve and sensory fibers are more sensitive than motor fibers. The site of fistula had no affect on the rate of development of ischemic neuropathy. We recommend using electrodiagnostic study for screening of ischemic neuropathy every 6 months in hemodialysis patients

The Effect of Preoperative Oral Versus Parenteral Dextrose Supplementation on Pain, Nausea, and Quality of Recovery After Laparoscopic Cholecystectomy

Purpose: Earlier studies suggest that carbohydrate loading is effective in reducing preoperative nausea. This study was conducted to investigate the effect of preoperative oral versus parenteral carbohydrate loading on the postoperative pain, nausea, and quality of recovery (QoR). Design: Three-arm randomized, single-blind clinical trial. Methods: In this study, 95 adult patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups of preoperative intravenous dextrose 10 infusion, oral carbohydrate (OCH)�rich drink, and control. The pain and nausea severity scores were measured during recovery, 6 hours, and 24 hours thereafter. The 40-item QoR score was evaluated the day after surgery. Findings: In recovery, nausea severity was comparable among three groups, whereas pain score in the OCH group was significantly less than the controls (P = .009). Pain score in patients who received intravenous dextrose was mediocre and not statistically different from two other groups. Six and 24 hours after surgery, nausea and pain scores in OCH and dextrose infusion groups were significantly lower than the control group (P < .05). The 40-item QoR score was significantly higher in intervention groups than control participants (P < .05). Blood glucose levels were comparable in three groups before and after surgery. Conclusions: Preoperative carbohydrate loading significantly improves the QoR after laparoscopic cholecystectomy without significant effect on blood glucose levels. Oral route more effectively controls nausea and pain than parenteral dextrose administration. © 2020 American Society of PeriAnesthesia Nurse

Patency and outcomes of tunneled hemodialysis catheter via femoral versus jugular vein access

The design of a suitable catheter to achieve a permanent, economical, and efficient vascular pathway for hemodialysis has been always accompanied by difficult and potential complications. Various strategies have been adopted to minimize the use of tunneled catheters that are used for dialysis. Regarding this, the present study aimed to assess the success, patency, as well as early and late complications of cuffed femoral and jugular hemodialysis catheters. This case-control study was performed on 145 hemodialysis patients who were candidates for the insertion of tunneled hemodialysis catheters at Rasoul-e-Akram Hospital in Tehran, Iran, during 2015-2016. The data were collected retrospectively by reviewing the patients' medical records. The participants were divided into two groups of femoral and jugular accesses, based on the type of catheter they had. To determine the procedure-related outcomes, they were assessed 1 week, 1 month, and 6 months after catheterization. According to the results, the mean times of catheter efficacy (patency) were 4.43 ± 3.11 and 5.65 ± 4.57 months in the femoral and jugular access groups, respectively, showing no significant difference between the two groups (P = 0.095). Furthermore, the femoral and jugular access groups had the infection prevalence of 23.2 and 16.2, thrombosis prevalence of 28.6 and 20.9, and mortality rates of 3.5 and 1.4, respectively. According to the multivariable linear regression model, the history of catheterization could predict reduced catheter patency. In addition, catheter-related infection could be predicted among females based on the multivariate logistic regression analysis. As the findings indicated, femoral and jugular hemodialysis catheter insertions showed no significant difference in terms of the mean patency, complications (e.g., infection and thrombosis), and mortality rate. © 2019 Journal of Advanced Pharmaceutical Technology & Research | Published by Wolters Kluwer - Medknow

Genetic variability of tolerance to Verticillium albo-atrum and Verticillium dahliae in Medicago truncatula

Verticillium wilt caused by Verticillium albo-atrum and Verticillium dahliae is responsible for yield losses in many economically important crops. The capacity of pathogenic fungi to adapt to new hosts is a well-known threat to the durability of resistant crop varieties. In the present work, 25 Medicago truncatula genotypes from a core collection and six V. albo-atrum and V. dahliae strains were used to study the potential of non-host Verticillium strains isolated from different plant species to infect this legume plant and the plant's susceptibility to the pathogens. The experiment was designed as factorial with randomised complete blocks and with three repetitions. The wilt symptoms caused by V. albo-atrum and V. dahliae were scored on a disease index scale from 0 to 4, during 30 days after inoculation of 10-day-old plantlets. Disease severity was quantified by maximum symptom scores (MSS) and areas under the disease progress curves (AUDPC), which integrate the time course of symptom development. Highly significant differences were observed among plant genotypes and fungal strains, and their interaction was also significant. The correlation between MSS and AUDPC was 0.86. The most severe symptoms were caused by the alfalfa strain V. albo-atrum V31-2 and the least severe by V. dahliae JR2, as shown by mean values obtained on the 25 genotypes. M. truncatula genotype TN8.3 was the most susceptible genotype by mean values obtained with the six fungal strains, whereas F11013-3, F83005.9 and DZA45.6 were highly resistant to all strains studied. The results can be used to choose parents for studying the genetics of resistance in Medicago truncatula to Verticillium strains with different levels of aggressiveness