Evaluation of diagnostic value of sentinel lymph node biopsy in breast cancer

Dissection of the axillary lymph nodes is considered as one of the common measures in management of breast cancer. Edema and limitation in hand movement are accompanied with dissection of axillary lymph nodes. Sentinel lymph node biopsy can be used to evaluate axillary metastasis. This study was carried out to evaluate the diagnostic value of sentinel lymph node biopsy in patients with breast cancer. This descriptive study was performed on 30 selected patients with breast cancer less than 5 cm without any involvement of axillary lymph nodes in Ghaem Hospital in Mashhad, North-East of Iran during 2009 -10. Initially, the lymphoscintigraphy was performed. Subsequently, prior, to the surgery, the blue dye as a marker was injected for detecting sentinel lymph node and with the use of probe gamma counter and observing blue color on lymph nodes, the sentinel node was determined and separated. Finally, axillary dissection was performed for removing the lymph nodes of I and II level in all patients. Among 30 patients who were evaluated for sentinel lymph nodes and axillary dissection, false negative were observed only in two cases [6.6%]. The sensitivity rate was determined to be 84.6%. Considering the high success rate of detection of sentinel lymph node and limited false negative cases, sentinel lymph node biopsy is recommended in cases of breast cancer without axillary involvement

Study of lymphedema risk factors among patients with invasive breast cancer after the initial treatment

Introduction: Upper limbs lymphedema is one of the rather common and debilitating sequels of breast cancer treatment. The incidence of this sequel has been reported in different sources to be from 25% to 38%. The purpose of this study was to evaluate the incidence and the risk factors of lymphedema following invasive breast carcinoma treatment

Materials and Methods: Recorded data of breast cancer patients referred to Mashhad Omid Hospital between 1997 and 2005 were evaluated for the incidence and risk factors of lymphedema. Univariate and multivariate analysis were performed to evaluate the risk factors using a logistic regression model

Results: Out of 312 patients entering the study 101 patients [32.4%, 95% CI: 27.2-37.6] developed lymphedema. Univariate analysis did not show a statistically significant difference between the rates of lymphedema in radical mastectomy when compared to other types of surgery such as lumpectomy with axillary dissection. Obesity according to body mass index significantly affected the development of lymphedema [p=0.03]. The average number of metastatic nodes was 4.56 +/- 4.05 in patients who had and 2.48 +/- 3.19 in patients who did not have lymphedema [p<0.01]. The average percentage of metastatic to excised nodes was%54.59 +/- 37.48 in patients who had and%34.67 +/- 34.84 in patients who did not have lymphedema [p<0.01]. Age, the number of excised nodes, the stage of disease, hormonal therapy, adjuvant radiation therapy and chemotherapy had no correlations with lymphedema

Conclusion: According to our findings, body mass index, the number of metastatic nodes and the percentage of metastatic to excised nodes were correlated with the development of lymphedema

Serum lipid level in obese subjects with body mass index of over 40

According to the definition given by the National Institute of Health, obesity is a chronic disease that may cause some other diseases in humans. Body mass index [BMJ] is used for the evaluation of obesity. Obesity will be considered sever when BMI is over 40. In such cases, lipid disorders could be speculated. The objective of this study was to assess the frequency of lipid disorders in subjects with the BMI of above 40. Two hundred patients with the BMI of over 40 were entered in this prospective study. Their lipid profile including serum total cholesterol, triglyceride, LDL and HDL were determined and correlated with the ratio of BMI and Waist to hip. The effects of other risk factors such as diabetes, pregnancy and osteoporosis on the subjects' lipid were also evaluated. The average age of the obese subjects was 40 years, ranging from 19 to 63. 81% of the subjects were female. The mean level of BMI was calculated as 44.42 +/- 4.4 [40.04-67.62]. Additionally, the mean level of cholesterol, LDL arid HDL were 244 +/- 30.63, 159 +/- 31.22 and 33.95 +/- 2.72 mg/di, respectively As for the mean level of triglyceride, the findings of the study came up with an average of 168.69 +/- 72.16 [72-260]. The frequency levels of abnormal LDL and HDL were found to be 81.5% and 100%, respectively. The avenge ratio of Waist to hip was measured as 0.86 +/- 0.2. 11.5% of the subjects were suffering from diabetes. The findings of the study suggest no significant correlation between diabetes, pregnancy or osteoporosis with BMI. Lipid profile in obese subjects showed abnormal cholesterol, LDL and HDL level that increase the risk of cardiovascular events

effects of adenotonsillectomy on pulmonary arterial pressure by doppler echocardiography in children

Increeased upper-air way resistance resulting from hypertrophic tonsils and adenoids can cause intermittent airway obstruction, chronic alveolar hypoventilation, and even severe cardiopulmonary complications like pulmonary hypertension and corpulmonale. The aim of this study is to clarify whether tonsillectomy and adenoidectomy have any effect on mean pulmonary arterial pressure. This prospective study was approved by ethic committee. Thirty two randomly selected children [16 male, 16 female] aged between 3.5 and 13 [mean 7.06 +/- 1] with a diagnosis of upper airway obstruction or chronic infections from hypertrophied tonsils and adenoids were included in our study. Mean pulmonary arterial pressure [MPAP] was measured using Doppler echocardiography preoperatively and mean 4.25 +/- 0.46 months postoperatively in all subjects. Comparing preoperative and postoperative mean pulmonary arterial pressure showed a statistically significant decrease in mean pulmonary arterial pressure in these children [Preoperative mean PAP=19.37 +/- 0.82, postoperative mean PAP= 18.10 +/- 0.6]. [p=0.004]. 10 of the 32 subjects in the study group were pulmonary hypertensive preoperatively. MPAPs of 9 of these children decreased to normal range. [P=0.004]. This study showed that obstructive adenoid and tonsillar hypertrophy causes higher MPAP values in children that would be reversible by performing early adenotonsillectomy

Psychological and obstetric risk factors for postnatal depression

Postnatal depression is a key concept for mother-infant mental health. Identifying risk factors of postnatal depression and developing screening system are needed. The propose of this study was to determine Psychological and obstetric risk factors for postnatal depression. 288 consecutive admitted women at 6-8 weeks after childbirth on maternity ward in Ghaem hospital, Mashad, Iran were assessed by two psychiatrics. Interview data included presence obstetric history, economic and demographic characteristics, Personality, psychiatric history and life-events information that were obtained from a questionnaire, psychological status was assessed by using the GHQ. The prevalence of distress was ascertained by the 28- item Goldberg Health Questionnaire [GHQ], using a cut-off score of> 24. 57.6% of mothers had GHQ-above 24 scores which categorized them as having significant emotional distress several psychological and obstetric risk factors for the development of predisposing psychological distress at 8 weeks postpartum were reported including: Economical situation, marital relationships, and the gender of the infant, multiparous women, caesarean section deliveries, and unplanned pregnancy. The results emphasize the importance of cumulative psychosocial and obstetric risk factors for postnatal depression. Early identification of potential risk for postnatal depression should include assessment of sociodemography, personality, psychiatric history and recent life events, as well as past and present obstetric factors