Cervical lymph node involvement by medullary carcinoma of unknown origin; a rare presentation

Medullary thyroid carcinoma [MTC], comprising 5-10% of all cancers, is a rare malignancy which frequently spreads to cervical lymph nodes. Occurring in both the sporadic and familial forms, the latter accounts for 20-25% of cases, while the former is considered the most frequent type. We report a case of metastatic MTC presented with cervical lymphadenopathy in a patient without evidences of MTC in thyroid gland

Surgical management of localized Crohn's disease of the fourth part of the duodenum

Upper gastrointestinal tract [gastroduodenal] Crohn's disease [CD] is an uncommon condition, occurring in about 1-5% of all CD cases. Our case was an extremely rare manifestation of CD, who presented with distal duodenal obstruction. As preoperative diagnosis was not established he underwent segmental resection and end-to-end anastomosis. Postoperative small bowel fistulae were not observed, and there was no morbidity during the follow up period. There were no disturbances in digestive function

Trans-thoracic versus trans-hiatal esophagectomy complications and outcomes in patients with esophageal cancer in Shohada-E-Tajrish Hospital, Tehran, Iran; 2000-2008

Esophageal cancer is a poor-prognosis cancer which is common in Iran. The main treatment for this cancer is surgery which may be performed with either trans-thoracic [TTE] or trans-hiatal esophagectomy [THE]. Each of these methods has some specific complications, morbidity and mortality rate, leading to controversies in method selection. Therefore, in this study we evaluated the outcomes of these two approaches in Iranian patients. In this retrospective survey, we evaluated 100 patients with esophageal cancer who underwent either TTE or THE in Shohada-e-Tajrish Hospital, Tehran, from 2000 to 2008 and categorized them into two groups. The patients in the two groups were compared according to age, sex, tumor location and histopathologic characteristics, surgery results and complications, morbidity, mortality and death results. Sixty nine percent [69%] of patients had squamous cell carcinoma [SCC] and 59% had undergone THE. The mean age of the patients was 61.18 years. There was no difference in age, sex distribution, tumor pathology and location in the two groups. Although neck leakage of anastomoses was more frequent in THE [7.31% vs 10.16%], there was no statistically significant difference between the two groups in complications and mortality. Duration of the surgery was longer in TTE. Trans-hiatal and trans-thoracic esophagectomy are the same in outcomes. Both methods can be considered as therapeutic surgical approach regarding to physician's opinion and patient's situations

sensitvity, specificity, positive and negative predictive values of stool color test, triangular cord sign and hepatobiliary scintigraphy in diagnosis of infantile biliary atresia

It is very important to detect biliary atresia in a timely manner to prevent progressive damage to the liver. Our attempt was to formulate our diagnostic approach to infantile cholestasis in Mofid Children's Hospital in Iran. Forty two records of infants with prolonged conjugated cholestatic jaundice from 2003 to 2008 were reviewed with regard to the infants' gestational age, birth-weight, stool color, liver function test results [total bilirubin, direct bilirubin, ALT, AST, alkaline phosphatase, albumin, globulin, and cholesterol], ultrasonography, hepatobiliary scintigraphy findings, liver biopsy results and ultimately intra-operative cholangiographies [IOC]. Total bilirubin, direct bilirubin, AST, AST to ALT ratio, cholesterol, and globulin were significantly higher in infants with biliary atresia [BA] as compared to those in the other group. We found that gestational age and birth weight were significantly lower in infants without BA. Stool color sensitivity, specificity, positive predictive value, and negative predictive value in diagnosis of BA were 100%, 83%, 81%, and 100%, respectively. These figures for triangular cord [TC] sign were 72%, 91%, 86%, 81%, respectively and for hepatobiliary scintigraphy were 100%, 85%, 100%, and 85%, respectively. In biliary atresia, history, physical exam, and liver function tests can be the first steps in diagnostic algorithms followed by colored stool. However, if TC is not visualized, hepatobiliary scintigraphy is suggested. If excretion of tracer does not occur, liver biopsy is indicated. The definite diagnosis would be possible by an intraoperative cholangiography

Anastomotic leakage following low anterior resection of rectal cancer considering the role of protective stoma

Probable risk factors of clinical anastomotic leakage and the role of defunctioning stoma in patients undergoing low anterior resection [LAR] for rectal cancer, is still controversial. The goal of our study was to find out possible risk factors of anastomotic leakage and to locate the influence of protective stoma in the rate of anastomotic leakage. In this retrospective study, 44 patients underwent LAR with total mesorectal excision [TME] during the period from 2001 to 2006 were analyzed. From these 44 patients 24 were treated with protective stoma while 20 were not. Overall anastomotic leakage rate was similar among patients with and without protective stoma [odds ratio=0.51, P=0.2357]. Male gender, Low anastomosis, Coronery Artery Disease, preoperative radiotherapy, and smoking were great risk factors for developing anastomotic leakage. We did not find any differences between handsewn and stapled anastomosis [odds ratio = 0.6]. protective stoma will be helpful depending on surgeon experiences and is not recommended for all the patients routinely. Beside this, male gender, low anastomosis, coronary artery disease, preoperative radiotherapy, and smoking are the major risk factors of anastomotic leakage