[Report of two cases of familial chronic pancreatitis]

Chronic Pancreatitis is a rare inflammatory Disease which can occur due to Different Causes such as: Alcohol consumption, Hyperparathyroidism Hypertriglyceridemia Pancereatid divisum [1]. Chronic Pancreatitis can be Sub grouped as: Lithogenic, obstructive, Inflammatory, Autoimmune, Idiopathic pancreatic fibrosis, Tropical, Familial. We report two cases of familial chronic pancreatitis in 5 and 16 years old girls which were cousin. Both girls referred with epigastric pain with radiation to the back and chronic nausea and vomiting. With primary diagnosis of chronic pancreatitis both patients went under ERCP and panceratograhy which revealed dilation and Irregularity of pancreatic duct with stone. Both cases operated by Fery procedure [Longitudianl Roux-en-y] Pancreaticojejunostomy. Postoperatively, both girls were symptom free and normal life

Five and ten years survival in breast cancer patients mastectomies vs. breast conserving surgeries personal experience

Breast carcinoma is the first malignancy among Iranian ladies and the second cause of death due to cancers after gastric carcinoma. According to the World Health Organization the annual incidence rate of breast cancer will rise 1.8 to 2 percent. It is one of the most important health problems. Five year survival is one of the indicators used for evaluation of the quality of care to different types of malignancies. In this study we decided to compare the result of mastectomy and breast conserving surgery in the survival of patients with breast carcinoma. This is a retrospective study using data from breast carcinoma cases in a private clinic under supervision of the author during years 1994 until 2007. These cases base on the clinical status underwent surgery as mastectomy or breast conserving with other necessary treatment. The number of patients with acceptable follow up was 464 cases that 441 were included to define survival. The data were analyzed by SPSS and survival estimated by Kaplan Mayer method. Survival curve was estimated for 441 cases of them, six cases were men and the age of patients was 22 to 104 years old with average of 53.24 years and standard deviation of 12.41. The most cases were among 45-55 years old. Five and ten years survival for all cases was 81% and 77% respectively. These data for mastectomies patients was 78 and 70 percent and for breast preserving cases was 86 and 78 percent which was not significant in log rank test with p-value equally 0.13. There was no significant difference between mastectomies patients versus breast preserving cases in all clinical stages although the crude data shows better situation in breast preserving surgery [BPS]. Breast cancer is one of the most important health problems, nowadays breast preserving surgery is choice treatment for stage I and II throughout the world. In this study overall 5 years survival was 81% comparable with developed countries with different health delivery system and quality of care and it is much better than other reports from Iran, regional and comparable countries. Because of many reasons such as physical, social and psychological effect of BPS, we recommend it as the best choice for managing breast cancer patients in stage I and II and even III in clinically approved cases in Iran similar to other countries

[Comparing AVF ligature and transvenous endorrhaphy for AVF closure in hemodialysis patients]

Arteriovenous fistulae are the principal chronic hemodialysis access in patients with end stage renal disease. There is an increasing number of patients who need AVF closure because of serious complications or renal function retrieval by transplantation. Multiple open and endovascular techniques have been proposed for AVF closure. In this study, we are going to compare two surgical methods and select the preferred one as the standard technique for closure. A randomized controlled clinical trial was designed. 140 patients were randomly assigned into two matched groups. 70 patients underwent AVF ligature and the other 70 subjects underwent transvenous endorrhaphy. Each patient was followed for at least 6 months to monitor surgical results. Of 140 patients, 26 [18.6%] AVF closures were failed during 6 months of follow up. Of 26 failed cases, 24 had undergone AVF ligature. Thrill recurrence and closure failure was 37.1% in the ligature group and 2.9% in the endorrhaphy group. Transvenous endorrhaphy is associated with better AVF closure results. Therefore, we recommend this procedure as the standard technique of AVF closure

[Isolation of anaerobic, aerobic bacteria and mycobacterium from foot skin infections of diabetic patients]

Diabetic foot infections are a potentially severe complication of diabetes. Diabetic foot infections can sometimes lead to long-term debilitation and, in the most severe cases, amputation. They are the most common infections in patients with diabetes, whose weakened immune systems put them at an increased risk of acquiring antibiotic resistant infections. For this descriptive study, 120 diabetic patients [30 women and 90 men age ranged between 45-65 years and disease duration of 0.5 to 37 years] were investigated. Immediately after the hospitalization, specimens from infected foot lesions were taken using Thio and BHI as transport medium. Aerobic cultures were carried out in all cases according to conventional methods while anaerobic cultures were performed when appropriate. Finally, susceptibility tests were performed on isolated microorganism. Totally, 75% of cases were polymicrobial infections. We isolated gram positive cocci 95%, gram positive bacilli 35%, gram negative 55% and mycobacterium 10%. Meanwhile, we found that 12.5% of our bacteria were anaerobic and 87.5% were facultative aerobic bacteria. In antimicrobial susceptibility testing, Rifampin was the most effective antibiotic against S.aureus and peptostreptococcus. Surprisingly, E.coli was resistant to all tested antibiotics. Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be prescribed on the results of microbiological investigation