[ effect of esophagectomy and cervical esophagogastrostomy with or without of pyloromyotomy on emptying of intrathoracic stomach]

A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure. The aim of this study was to determine the emptying of the intrathoracic stomach after esophagectomy and cervical esophagogastrostomy with or without pyloromyotomy. Between January 2003 and April 2006, in a randomized controlled trial, 30 patients with esophageal carcinoma were randomized to have with or without pyloromyotomy as a gastric emptying procedure for the gastric conduit used for esophageal replacement. Patterns of gastric emptying in the vagotomized intrathoracic stomach were studied using radioisotope techniques. Gastric emptying [GE] was evaluated 8 weeks after the operation. Patients were available for 6 months follow-up. A total of 30 patients were enrolled in this study. Sixty percent [18] were male, and 40% [12] were female. Twenty three patients [76.7%] had squamous cell carcinoma and 7 [23.3%] had adenocarcinoma. Delayed GE was reported in 11 [73.3%] and normal GE in 4 [26.7%] of patients with Pyloromyotomy. Delayed GE was reported in 9 [60%] and normal GE in 6 [40%] of patients without Pyloromyotomy. There were not any significant differences between complications of post surgery in both groups. These findings were showed that esophageal surgery can be don't add a pyloric drainage procedure in esophagectomy and cervical esophagogastrostomy and that very few patients actually need it

[Comparison the effect of corticosteroid injection with physiotherapy in treatment of painful arch of shoulder]

Painful arch of shoulder is treated using both surgical and non-surgical methods. In the latter one, steroidal and non-steroidal analgesic drugs and/or physiotherapy are used. The aim of this study was to compare the effects of corticosteroid injection and physiotherapy in the treatment of disease. In this double-blinded clinical trial, 124 patients who referred to Shahrekord Kashani hospital and suffered from shoulder pain or with having limitation in its movement were considered as the patients with painful arch of shoulder. They were divided in two equal groups of 62. In the first group, 40 mg of prednisolone was locally injected in the painful site. The second one was subjected to ten sessions of physiotherapy for two weeks. The outcomes of these treatments were assessed using a questionnaire including shoulder disability and the amount of pain in the patients, 2, 6, and 11 weeks after the treatment. Data were analyzed using statistical analysis [X[2], t and repeated measures ANOVA]. The mean age of the patients was 42.3 +/- 9.5 years. The two groups were age and sex matched. The pain was relapsed in one patient of the first and 3 patients of the second group. Pain and shoulder disability were significantly decreased in the two groups [P<0.05]. The amount of shoulder disability and pain in the group received corticosteroid was less than that in the group subjected to physiotherapy [P<0.05]. Base on the results, injection of corticosteroid is more effective than using of physiotherapy in treatment of painful arch of shoulder. This cures pain and shoulder disability of the patients faster

[ speed of decreasing of arterial oxygen saturation following induction of anesthesia, using 3 methods of pre-oxygenation techniques]

Determination of preoxygenation before anesthesia is an important factor in prevention of hypoxia and its complications. Regarding the height of Shahrekord from the sea surface [2061 m] and low level of oxygen pressure in this area [600 mg], this study was aimed to determine the onset of desaturation of oxygen following, using of three pre-oxygenation methods in apnostic adult healthy patients. In this clinical single blind study, sixty-six healthy, non-smoker adults undergoing elective surgery were randomly divided into three groups. Following the record of systolic and diastolic blood pressure and heart pulse from the patients, group one were not pre-oxygenated, groups two and three were pre-oxygenated with 50% oxygen and nitrous oxide and 100% oxygen, respectively for three minutes. After induction of the same anesthesia in the 3 groups, the patients were kept in apnostic until their saturated pressure O2 [SpO2] decreased to 91%. Subsequently, their systolic and diastolic blood pressure and heart pulse required to achieve SpO2 of 91% were measured. The data were analyzed using Chi-square and ANOVA tests. Mean age of the patients was 30.5 +/- 14.1 in whom 58% of them were male. All of the three groups were sex and age matched [p>0.05]. The delay time to achieve SpO2 in group one, group two and group three were 44 +/- 16, 114.3 +/- 36.8 and 241.6 +/- 84, respectively [p<0.001]. In all of the 3 groups, the increasing of heart pulse after the intervention was significantly different compared to before that [p<0.001]. However, the difference was not significant between the groups. Pre-oxygenation of the patients for 3 min. before induction of anesthesia with normal breathing and with 100% oxygen would significantly increase the time required for oxygen saturation of the patients to 91%