[Inoperable esophageal cancer and outcome of palliative care in Golestan province, Iran]

Dysphagia is the most distressing problem in patients with advanced inoperable esophageal cancer. Palliative interventions like balloon dilation and stenting are used to improve quality of life and make patients enable to eat more comfortably. This study was designed to determine the outcome of palliative care in esophageal cancer patients referred to Gorgan and Gonbad gastrointestinal clinics, northeast Iran. This cross-sectional study was performed on inoperable esophageal cancer cases during 2005-2006. Demographic data were collected during the procedure and cases were followed every month for six months. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness. We recruited 39 cases into the study. Male to female ratio was 1.6 to 1 and mean age was 67.5 +/- 13.7 years. Twenty two patients had grade 3 dysphagia and other 17 had grade 4 at the begining of the study. Dilation was the most preferred method [89.7%] and stenting was performed in 4 [10/3%] cases. Decreasing dysphagia score was not related to palliation method used or pathologic type of carcinoma but it was showed to be related to the age of the patients significantly. Mean survival was significantly different between 2 groups [with and without dysphagia improvement in first month of follow-up]. Results of this study showed a lower survival rate after palliative care in advanced esophageal cancer cases, although dysphagia scores showed some improvement

Isolated gastric tuberculosis; A case report

Tuberculosis is an important problem in the world and Iran. Tuberculosis is an ancient disease but because of different presentations is a mysterious disease too. A 20-year-old girl who complained of abdominal pain with peptic ulcer and weight loss was admitted in our hospital. Since 4 months ago before referring, she had been treated many times for peptic ulcer including treatment for helicobacter pylori. Then endoscopy and biopsy were done. In endoscopy one ulcer in antrum with malignant appearance was observed. At biopsy granulomatous inflammation compatible with tuberculosis reported. She was treated by anti-tuberculosis drug for six months. Endoscopy repeated after 2 months of therapy showed completely normal pattern and she had 5 kg weight gain and totally symptom free after completion of therapy. Gastric TB should be considered for differential diagnosis of patient with gastric symptoms in endemic regions

[Familial risks of esophageal cancer in the Caspian Littoral of Iran]

In northeastern Iran there is an area of high incidence of esophageal cancer which is populated by residents of Turkmen ancestry. Several environmental risk factors for esophageal cancer have been proposed, but the roles of familial and genetic factors have not been studied extensively in the Turkmen population. We evaluated the importance of familial risk factors for esophageal cancer by performing a case-control study of 167 cases of esophageal squamous cell carcinoma and 200 controls of Turkmen ethnicity. Detailed family pedigrees of the cases and controls were constructed, which documented all cancers in first- and seconddegree relatives. The actuarial risk of cancer was then estimated in 2097 first-degree relatives of cases and 2783 first-degree relatives of the controls. A hazard ratio was constructed, based on a comparison of the two cumulative incidence curves. The risk to age 75 of esophageal cancer in the first-degree relatives of Turkmen patients with esophageal cancer was 34%, versus 14% for the first-degree relatives of the controls [hazard ratio = 2.3; p = 3 x 10[-8]]. 9.6% of the cases reported that their parents were related, versus 2.5% of the controls [odds ratio = 4.1; p -value = 0.006]. Familial factors are important in the etiology of esophageal cancer among the Turkmen residents of Iran. The hazard ratio of 2.3 for cancer among first-degree relatives is consistent with an important contribution of heritable factors. It will be of interest to perform marker studies to establish which genes are responsible