The Diagnostic Value of Serum Fibrinogen Level in the Diagnosis of Acute Appendicitis

Background and purpose: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. Diagnostic tests with high accuracy could lead to immediate diagnosis and timely surgery could prevent further complications. This study was performed to assess the diagnostic value of serum fibrinogen level in diagnosis of acute appendicitis. Materials and methods: This cross-sectional diagnostic study was performed in patients (n=165) attending the emergency department in Sari Imam Khomeini Hospital with an initial diagnosis of appendicitis and available histopathologic examination results in 2016-2017. Fibrinogen levels were measured before surgery. Student's t test, Mann-Whitney test, and Chi-square were used to examine the relationship between fibrinogen level, demographic and clinical variables, acute appendicitis, and complicated/uncomplicated appendicitis. ROC Curve test was also performed and indicators associated with diagnostic accuracy were calculated. Results: The mean fibrinogen level in patients with normal appendices was 278.0±50.5, while it was 349.4 ± 68.7 in those with appendicitis (P<0.0001). The area under the curve was 0.794 (CI = 0.724-0.853). Moreover, at the optimal cut-point of fibrinogen level of 344 mg/dl, the sensitivity, specificity, negative predictive value, and positive predictive value were 51.7%, 90.4%, 94.4%, and 37.6%, respectively. Positive and negative likelihood ratios were 5.43 and 0.53, respectively. Conclusion: This study showed that measuring serum fibrinogen levels, as an acute phase reactant, is useful for diagnostic screening of acute appendicitis and for predicting complicated appendicitis

Pulmonary Arteriovenous Malformation Surgery in a Pregnant Woman: A Case Report

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

The prognostic value of lymph node ratio in survival of head-and-neck squamous cell carcinoma

Background: Head-and-neck squamous cell carcinoma (HNSCC) is the sixth most prevalent type of cancers in the world. Due to its relatively high rate of recurrence, the prognosis of patients is poor and the survival rate is low; therefore, identifying the prognostic factors is considered necessary for better treatment. Materials and Methods: This historical cohort study was conducted on 201 patients diagnosed with aerodigestive SCC who underwent surgery and lymph node dissection. We determined the prognostic value of lymph node ratio (LNR) on overall survival (OS), disease-free survival (DFS), and locoregional failure-free survival (LFFS). We noticed an association between LNR and survival by Kaplan–Meier analysis. Hazard ratio (HR) of LNR was determined by Cox's regression model. Results: Two hundred and one patients entered this study after their medical histories were evaluated. The mean of lymph node count and LNR was 14.30 (±9.50) and 0.12 (±0.23), respectively. Eighty patients (39.80%) experienced recurrence of SCC. Five-year OS, DFS, and LFFS were 32%, 21%, and 64%, respectively. The median of OS was 40.70 months and 30.11 months in patients with LNR of ≤0.06 and >0.06, respectively (P 0.06 was found to be a significant prognostic factor for lower OS of patients with HNSCC (HR = 2.11 [1.10, 4.40]; P = 0.04). DFS was not significantly different among patients with LNR ≤0.06 and patients with LNR >0.06 (P = 0.9). However, LFFS was slightly different among two groups (HR = 2.04 [0.90–4.80]; P 0.06. Further investigations with larger sample sizes are recommended