Iliac vein stenting in a patient with lower extremity swelling resulting from diffuse pelvic mass: A case report

We report a 66-year-old male patient with severe right lower extremity swelling resulting from diffuse pelvic mass with compression on right external iliac vein. The patient had papillary urothelial carcinoma of bladder seven years ago and radical cystectomy and ureterostomy was performed. Recurrence of malignancy had occurred five years after the operation. The patient had also bilateral diffuse lung metastasis. The external iliac vein had severe stenosis and invasion of pelvic mass into the vein was evident on venography. Venoplasty of external iliac vein was performed throughout the stenosis. A venous stent of 80 mm length and 12 mm diameter was introduced over the guidewire and deployed in the external iliac vein. Dramatic clinical response was evident since postoperative day two. Swelling of right lower extremity was resolved dramatically on three-month and six-month follow-up visits. We believe that endovascular venous recanalization of iliac veins is feasible and safe in patients with unresectable and diffuse pelvic masses

Effectiveness of Mouth Washes on Streptococci in Plaque around Orthodontic Appliances

Background and Purpose. Fixed orthodontics may be associated with accumulation of Mutans Streptococci (MS), enamel demineralization, and an increased number of carious lesions, predominantly in sites adjacent to brackets. This study was undertaken to assess the effectiveness of Listerine, Oral-B, and Ortho-kin on the accumulation of MS in plaque around orthodontic brackets. Materials and Methods A double-blind randomized cross-over clinical trial on 25 orthodontic patients, classified into 6 groups was done to assess MS in plaque and saliva with the side specific modified Strip-Mutans technique and the plaque (PI) was measured before and after rinsing using 3 types of commercial mouth-rinses. A washout period (3 weeks) was awaited between using each mouth-rinse and the data was analyzed via Wilcoxon and Kruskal Wallis statistical tests. Results. This study of 25 patients, 5 men and 20 women, with an average age of 19 ± 6/3 assessed the effectiveness of mouth-rinses on MS. Our results showed that Ortho-kin had a better effect than Oral-B and Listerine (P < 0/09). Ortho-kin also had better effects than Oral-B and Listerine on plaque accumulation (P < 0/001). Conclusion. Ortho-kin showed better effects on decreasing MS and PI because it contained chlorhexidine

Local versus radical surgery for early rectal cancer with or without neoadjuvant or adjuvant therapy

Background: Total mesorectal excision is the standard of care for Stage-I rectal cancer. Despite major advances and increasing enthusiasm for modern endoscopic local excision (LE), uncertainty remains regarding its oncologic equivalence and safety relative to radical resection (RR). Methods: We performed a comprehensive search of major electronic databases, trial registries, and grey literature for randomized controlled trials (RCT) comparing LE versus RR with or without use of neo/adjuvant chemoradiotherapy. We used standard Cochrane Collaboration methodological procedures. Oncologic, surgical, and functional outcomes were sought and compared using a generic inverse variance and random-effects models, where appropriate. Results: Of eight potential studies, only three RCTs were complete and included in data synthesis with a combined total of 211 patients. Risk of bias was judged as unclear for oncologic outcomes across studies and high for surgical morbidity outcomes. Disease-free survival was comparable between LE versus RR (hazard ratio (HR) 1.48, (95% confidence interval (CI) 0.54 to 4.02; low-quality evidence, translating into 8.1% vs. 5.6% disease recurrence after LE and RR, respectively). Similarly, there was no difference between LE versus RR in cancer-related survival, local recurrence-free survival, or metastasis-free survival. There were no cases of 30-day mortality after any of the interventions. Risk of major postoperative complications was not significantly lower with LE (risk ratio 0.56, 95%CI 0.21 to 1.51; very low-quality evidence; corresponding to 5.2% for LE vs. 9.3% for RR). Very low-quality evidence suggested a non-significant trend for fewer minor postoperative complications after LE (risk ratio 0.53, 95% CI 0.28 to 1.03; very low-quality evidence; corresponding to 16.2% for LE vs. 30.6% for RR). One study reported 24% rate of definitive stoma only after RR. Data suggested shorter length of stay after LE. No objective data was available regarding sphincter function, quality of life or genitourinary function in any of the studies. Conclusion: Based on limited and low to very low-quality evidence, this review suggests an equal role for LE in terms of oncologic and operative outcomes in patients with early-stage rectal cancer. If further supported by more RCTs, LE has the potential to become the preferred approach in these patients.Medicine, Faculty ofSurgery, Department ofGraduat

A comparison of laboratory findings in coronary artery bypass surgery with and without cardiopulmonary bypass

Background : Quests for doing coronary artery bypass surgery by a technique with lower complications is going on, for this aim many studies compared patients undergoing CABG with or without cardiopulmonary bypass. This study was carried out to compare laboratory findings after coronary artery bypass in these two groups of patients. Materials and Methods: In a retrospective study, 167 patients undergoing CABG with or without cardiopulmonary bypass were selected by systematic randomized sampling method from the list of the Jamaran Hospital (Tehran) patients and the blood levels of glucose, creatinine, potassium, sodium and incidence of acute kidney injury were compared. Results: Occurrence of acute kidney injury and glucose, creatinine and potassium levels was more in CPB group (P<0.05), but the sodium level was equal in both groups (P=0.84). Conclusion: OPCAB facilitate reduction in the incidence of acute kidney injury and control of the serum glucose and creatinine levels and complications related to these factors. It seems that OPCAB is an optimal operation technique for patients, but other factors should be considered too