evaluation of the relationship between the initiation times of feeding through Jejunostomy and procedure complications after upper gastrointestinal [hypopharynx-esophagus] malignancy

Jejunostomy is a common route for enteral nutrition in patient s with upper gastrointestinal [hypopharynx-esophagus] surgery. The aim of this study was to assess the relationship between the starting time of feeding through Jejunostomy with this resulting complications and suggesting a new guideline to reduce complications of the procedure. In a clinical trial study in Amir-Alam hospital patients with upper gastrointestinal malignancy underwent Jejunostomy in a 3 year- period. The patients divided in two groups and complication rates compared feeding through Jejunostomy group [A] 6 hours after the main surgery and group [B] 3 days after the main procedure. Ninety patients [41 male, mean age: 55 yr of age ranging 20-90yr] with upper gastrointestinal malignancy were recruited. In each group twenty seven [30%] of the patients did not complain of any side effect during enteral nutrition .The complications of Jejunostomy procedure in group [A] 6 hours and in group [B] 3 days after the main surgery was seen in 12/37 [32%] and 13/53[24%] of the patients respectively. Significantly higher incidence of abdominal distention and fever was observed in group [A] patients who underwent enteral nutrition through Jejunostomy 6 hours after the main surgery, compared to group [B] [P=0.001] and [P=0.001], respectively. No significant differences in other complications were observed between the two groups. Feeding through Jejunostomy 3 days after the main surgical procedure shows lower adverse effect and because of its well toleration in upper gastrointestinal tract and hypopharyngeal cancer, this method is recommended for enteral nutrition in these patients

study of demographic and clinical features of patients referred to the nuclear medicine department of a military hospital for myocardial perfusion scintigraphy

It seems that demographic and clinical features of patients referred for myocardial perfusion scintigraphy [MPS] is different among populations and healthcare settings. The purpose of the current study is to evaluate the clinical features and risk factors of patients referred for myocardial perfusion scintigraphy to a military hospital. As a cross-sectional study, the clinical and laboratory data of all patients who were referred for MPS were recorded. MPS was performed using [99m]Tc-Sestamibi or Thallium-201 [Tl-201] as the radiotracer. From March 2005 to March 2006, the data of 1392 consecutive patients were recorded. The mean age of the patients was 55.3 +/- 14.8 years. 45.6% of the patients had no major risk factor, while 38.5% had one and 15.9% had two risk factors. Hypertension was the most common risk factor, while cigarette smoking was reported by eight percent of the patients. The method of stress protocol was dipyridamole infusion in 69.2%, Treadmill exercise test in 28.4% and dobutamine infusion in 2.4% of the cases. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of MPS in detection of angiographically positive CAD were 88.5%, 71.4%, 94.3%, 46.8% and 75.3%, respectively. In our population hypertension is the most frequent risk factor, so extensive social programs should be implemented aiming at controlling this variable, in order to prevent its possible cardiac complications. Cigarette smoking is less common than general population, which could be due to social characteristics of the target community and their beliefs, so this distinctiveness should be well defined and promoted. The differences in the pattern of cardiovascular symptoms and risk factors can be considered as indirect evidences to the fact that the pattern of referral for MPS in our country is significantly different from those in developed countries, a fact that warrants further evaluation in order to confirm its appropriateness based on the validated international guidelines