Effect of cardiac rehabilitation program on heart rate recovery in Coronary Heart Disease

Background: It has been suggested that the autonomic system function and the metabolic syndrome can significantly affect patients' survival. The aim of the current study was to investigate the impact of the cardiac rehabilitation program on the autonomic system balance in patients with coronary artery disease

Methods: Patients with a previous diagnosis of coronary artery disease who were referred to the Cardiovascular Rehabilitation Center of Afshar Hospital [Yazd, Iran] between March and November 2011 were enrolled. All the patients participated in rehabilitation sessions 3 times a week for 12 weeks. Heart rate recovery [HRR] was measured as an indicator of the autonomic system balance. In order to calculate HRR, the maximum heart rate during the exercise test was recorded. At the end of the exercise test, the patients were asked to sit down without having a cooldown period and their heart rate was recorded again after 1 minute. The difference between these 2 measurements was considered as HRR

Results: A total of 108 patients, including 86 [79.6%] men and 22 [20.4%] women, completed the rehabilitation course. The mean age of the study participants was 58.25 +/- 9.83 years. A statistically significant improvement was observed in HRR [p value = 0.040]. Significant declines were also observed in the patients' waist circumference [p value < 0.001] and systolic and diastolic blood pressures [p value = 0.018 and 0.003, respectively]. A decreasing trend was observed in the patients' body mass index, but it failed to reach statistical significance [p value = 0.063]. No statistically meaningful changes were noted in fasting blood glucose [p value = 0.171], high-density lipoprotein [p value = 0.070], or triglyceride concentrations [p value = 0.149]

Conclusion: The cardiac rehabilitation program may help to improve HRR and several components of the metabolic syndrome in patients with coronary heart disease

Predictors of sentinel node involvement in breast cancer

Background: Sentinel lymph node biopsy has shown to be a good alternative procedure for axillary lymph node dissection and to lead to lower frequency of morbidity, though this technique has its own side effects. It needs especial equipment and may not be available in some medical centers, especially in developing countries. This study aimed to identify a subgroup of patients with higher probability of metastasis to sentinel lymph node that can be excluded from indications of this procedure. Methods: In this cross-sectional study, the clinical data of 195 patients with breast cancer who underwent sentinel lymph node biopsy in Tehran, Iran, between 2009 and 2011 were reviewed. Whenever tumor features showed significant association with sentinel node metastasis in univariate analyses, logistic regression was used to identify independent predictors. Results: Univariate analyses revealed that tumor size and lymphovascular invasion have significant association with sentinel lymph node metastasis [P = 0.009 and P < 0.001, respectively]. Moreover, age had an significant association with positive sentinel lymph node biopsy [SLNB] [P = 0.004]. Other factors, including tumor grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not associated with positive sentinel lymph node biopsy in univariate analysis. All factors that showed significant association in univariate analysis remained statistically significant predictors of positive SLB in multivariate analysis. Conclusions: It seems that young breast cancer patients, those who have tumors larger than 5 cm and those with lymphovascular invasion, are at an increased risk of sentinel lymph node metastasis

Role of capitonage and fibrin sealant in reducing seroma formation after breast conservation surgery: a randomized clinical trial

Seroma formation is a common complication after breast cancer surgery. Several techniques such as tube drainage, fibrin sealant and suturing methods have been employed to prevent or reduce seroma formation. Capitonnage, a suturing method widely used following hydatid cyst removal, has been used after breast surgery in limited studies. Our aim was to compare the effectiveness of tube drainage, fibrin sealant and capitonnage to prevent early complications. Eligible patients with breast cancer who were candidate for breast conserving surgery were enrolled and randomized into three different groups [tube drainage, capitonnage, capitonnage plus fibrin sealant]. Patients were visited on 5[th],12[th] and 19[th] days after surgery and were assessed for any probable complications. A total of 90 patients were enrolled. One patient developed seroma in tube drainage and capitonnage group, while no participant from capitonnage plus fibrin sealant group experienced the mentioned complication. Three patients developed skin necrosis, all of them were treated with capitonnage plus fibrin sealant protocol. Based on our observations, it seems that capitonnage alone or in combination with fibrin sealant do not lead to significant differences in frequency of complications after breast cancer surgery such as hematoma, seroma and surgical site infection

Diagnostic performance of sonoelastography in addition to ultrasound in investigating breast lesions: can concomitant use of these techniques lead to improvement of differentiation?

Sonoelastography [SE] is introduced as a complementary technique for ultrasoungraohy [US] to evaluate breast lesions. This method is based on tissue strain in response to compression and decompression. The current study was designed to investigate the diagnostic performance of SE for differentiating between benign and malignant breast lesions A total of 35 women with 45 breast lesions who were referred to a university affiliated hospital in Tehran were enrolled. All patients were visited and examined by a same radiologist. A five-point scale was applied for categorizing lesions in SE as malignant or benign. The results of US and SE were compared with histopathological results to calculate sensitivity and specificity of each mentioned techniques. Histopathological evaluations in 12 cases were in favor of malignancy, and the rest of cases were classified as benign. The sensitivity and specificity for US were 100% and 69.7%, respectively. On other hand, SE obtained a lower sensitivity [58.3%] and higher specificity [90.9%] in comparison with US. simultaneous evaluation of suspicious breast lesions with both US and SE can have high sensitivity and specificity and prevent the unnecessary invasive interventions

Acute immunologic reaction to silicone breast implant after mastectomy and immediate reconstruction: case report and review of the literature

Since the introduction of silicone based medical devices in to clinical practice, several reports appeared in the medical literature regarding their adverse effects. However, there are few reports of immunologic reactions to these implants. A case of systemic reaction to a breast implant inserted for immediate breast reconstruction in a breast cancer patient is presented. The patient developed fever and skin rash two months after the surgery. Investigations disclosed no infectious origin for the fever and a dramatic response to steroid therapy was observed. Immunologic reaction should be considered in case of systemic signs and symptoms after silicone breast implant placement as a rare complication