Abdominal aortic aneurysm: a 5 years experience in Tabriz Imam Khomeini's hospital

Abdominal aortic aneurysm occurs as a result of chronic degenerative change in arterial wall. Less than 5% mortality rate has been reported for elective infra renal aortic aneurysm surgeries, however, ruptured aortic aneurysms operations have still remained as a main medical problem with a mortality rate of 30% to 70%. In this prospective study we intend to evaluate multifarious signs and factors in prognosis of 31 patients with abdominal aortic aneurism in Imam Hospital during the years 1379-1384. In this analytic-descriptive study, 31 patients with abdominal aortic aneurysm evaluated during the years 1379-1384 in Imam Hospital. These patients divided to 3 groups: 1. Elective patients [10 cases], 2.Unstable ruptured aneurysms [9 cases], 3. Stable ruptured aneurysms [12 cases]. All the patients sustained transperitoneal operation. Early mortality [less than 30 days], post operative morbidity and other prognosis impressive factors were documented. Mean age was 67.1 +/- 8.9 and male to female ratio was 22.9. Early mortality occurred in 77% of unstable ruptured aneurysm group, 25% of stable aneurism group and 10% of elective group. We found no specific relation between sex and mortality. Significant relation found between mortality and systolic blood pressure at the time of admission and presence of renal disease. Mean hospital and ICU stay were 9.1 +/- 5.6 and 4.1 +/- 2 respectively. In alive patients distal embolism and renal failure were the main postoperative complications. Elective surgery increase survival in patients with abdominal aortic aneurysms. However, high rate of rapture decreases the life expectancy. Mortality rate of elective surgeries was 10%. Considering 77% of mortality rate in ruptured and unstable group, it seems evaluation for early detection and in due time operation to be an extremity

[Chemoradiotherapy before transhiatal esophagectomy for esophageal squamous cell carcinoma-A pilot phase nonrandomized clinical trial in Tabriz Imam Khomeini Hospital]

With promising results from several institutions, many centers began to treat patients with esophageal squamous cell carcinoma [SCC] with neoadjuvant chemoradiotherapy followed by esophagectomy. The aim of this research is to determine the feasibility of this method in our selected patients. In this prospective phase I clinical trial, 10 patients [7 male, 3 female; 58.4 +/- 2.5 Y/O] with stage III and VIA lower thoracic esophageal SCC, were treated with intravenous infusion of 1000 mg/m[2]/day 5-flourouracil during day 1 to 4, 75 mg/m[2] cisplatin in day 1, and a total dose of 18 Gray external beam radiation during day 1 to 6 and underwent transhiatal esophagectomy during day 7 till 10. This group was compared with a retrospective group of 61 patients which treated with surgery alone. Age, sex, duration and grading of the dysphagea, differentiation and staging of the tumor were not different in these two groups. There is no complete pathologic response in the study group. One patient died because of severe leukopenia and sepsis and other because of azygos vein rupture. Other complications were: chylothorax which required later thoracotomy [10%], recurrent nerve paresis [10%], superficial wound infection of the neck incision [10%]. All patients had mild to moderate leukopenia [2600'400/mm3] during days 11 to 16. Total postoperative intensive care unit stay was 2.2 +/- 0.5 days and postoperative hospitalization was 15.7 +/- 1.8 days and in-hospital operative mortality was 20% and total morbidity was 50% which were not significantly different from control group [p<0.05]. Postoperative blood transfusion was 5.3 +/- 0.8 unit per patient which was significantly greater than control group[P<0.05]. The perioperative mortality and morbidity of this neoadjuvant protocol is acceptable comparing with our control group and we can propose phase II and III studies for determining the long-term effect of these protocol

Pancreaticoduodenal artery aneurysm: a rare cause of recurrent gastrointestinal bleeding

A case of pancreaticoduodenal artery aneurysm in a 63 year-old male is presented. The patient had multiple episodes of upper gastrointestinal bleeding due to communication of the aneurysm with the third portion of duodenum, through an ulcerated atheromatous plaque. This rare entity may cause upper abdominal pain and present as upper gastrointestinal bleeding