ABSTRACT
Although several treatments have been suggested for nasal polyposis, from medical to surgical, there is no standard guideline for the management of this disease. During recent years increasing attention has been directed toward the effects of macrolide antibiotics on chronic sinusitis and nasal polyposis. In this study, the efficacy of clarithromycin on severe nasal polyposis were examined. In a Prospective, before -after study, forty patients with severe nasal polyposis received clarithromycin 500 mg twice a day for 8 weeks. At the beginning and end of treatment, the severity of patients' symptoms [using subjective analogue scale], computed tomography [CT] scan and endoscopic findings were recorded. After treatment, the severity of nasal obstruction, smelling problems, Post Nasal Discharge and rhinorrhea decreased significantly [P0.05]. Furthermore, the degree of sinus opacification in CT scan and endoscopic findings showed significant improvement. Most patients completed their treatment course without significant side effects. Although a course of clarithromycin improved nasal symptoms, polyp size and CT findings, further studies with more patients are required to recommend this drug as a general treatment in nasal polyposis
ABSTRACT
Major salivary gland tumors are uncommon and the exact nature of these tumors is not obvious. This study was carried out to compare the histological results of intraoperative frozen sections against those of permanent reports for major salivary glands masses. One hundred thirty-nine patients with major salivary gland masses who were candidates for surgery underwent an intraoperative frozen section biopsy. A permanent histological examination was then performed for definite diagnosis and its result was compared with that of the frozen section. Sensitivity, specificity, accuracy and the positive and negative predictive values were analyzed. The frozen section had 98.4% sensitivity, 87% specificity, 97.1% accuracy, 98.4% positive predictive value and 87% negative predictive value in differentiating between non-neoplastic and neoplastic lesions. In addition, the frozen section's identification of a mass as either benign or malignant showed 98% sensitivity, 100% specificity, 99.2% accuracy, 100% positive predictive value and 99% negative predictive value. Based on the current study's findings, it can be suggested that the frozen section is considerably accurate in the diagnosis of malignant versus benign lesions of major salivary glands, regardless of the exact histopathological type of the malignant tumors.
ABSTRACT
Laryngeal videostroboscopy is an important noninvasive diagnostic tool in patients with dysphonia. More than 50% of patients with dysphonia have a benign laryngeal lesion on vocal fold examination. The aim of this study was to evaluate patients with benign laryngeal lesions by videostroboscopy. This cross-sectional study was done on 159 patients with dysphonia in Amiralam Hospital in Tehran, Iran during 2006-2007. All the patients underwent stroboscopic examination of the vocal folds, including their movement. We also evaluated the patients for mucosal status, mucosal wave and patterns of glottal closure. Eighty-two patients participating in the study were female and 77 were male. Reflux laryngitis and muscle tension dysphonia were the most observed disorders in the patient population. Patients with sulcus vocalis and intracordal cysts had the worst mucosal wave patterns. Laryngeal videostroboscopy is a useful tool for the diagnosis and treatment planning in patients with benign laryngeal lesions.
ABSTRACT
A study to validate and calibrate Pediatric Index of Mortality-2 [PIM2] in children admitted to our pediatric intensive care unit [PICU]. This is a prospective cohort study performed in Bahrami Children's Hospital affiliated to Tehran University of Medical Sciences. We studied the patients admitted to PICU from May 2007 to November 2008. Clinical measures were identified upon arrival in PICU. We used PIM2 score and logistic regression analysis to compare expected mortality risk with observed mortality rate. Receiver operating characteristics [ROC] curve analysis was done and standardized mortality ratio was calculated. PIM2 Index assessment was performed by use of Hosmer and Lemeshow goodness-of-fit test. 240 patients were included in this study. The model fit was achieved adequately [P value = 0.741]. The area under the ROC curve was 0.795 [0.715-0.875 for 95% confidence interval] and standardized mortality ratio was 1.8 [1.28-2.465 for 95% confidence interval] High-risk group diagnosis with adjusted odds ratio [AOR] =14.75, pupil reaction to light [AOR=0.13] and duration of stay in PICU [AOR=1.03] had significant statistical association to pediatric mortality. PIM2 is a good index for prediction of mortality in our pediatric intensive care unit. This study revealed that there is significant statistical association between the children mortality and the length of hspita;ization, pupillary light reflex and the risk level category on admission
ABSTRACT
Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare
Subject(s)
Humans , Male , Esophageal Neoplasms/diagnosis , Esophagus , Hoarseness , Deglutition Disorders , LiposarcomaABSTRACT
Nausea and vomiting after middle ear surgery as one of the most common complications after surgery is considered to become the ground for the incidence of other adverse consequences. The aim of this study was to evaluate the effect of 16 mg prophylactic intravenous dexamethasone on postoperative nausea and vomiting after stapedectomy. In a randomized double-blind controlled trial study, 70 patients candidate for stapedectomy divided into two equal groups, using the same sedation by single surgeon. While the case group received 16 mg Dexamethasone half an hour before surgery, the control group received 4ml intravenous saline as a placebo. Patients controlled 1-24 hours after the surgery in terms of nausea and vomiting and dependent variables such as vertigo and tinnitus. 70 patients [38 females and 32 males] were enrolled in this study. The rate of postoperative Nausea and vomiting in Case group was 31/4% [equal to 11 patients] and in control group was 60% [equal to 21 patients]. The different was statistical significant [p=%3]. The prophylactic use of 16 mg intravenous dexamethasone half an hour before surgery can significantly reduce incidence of nausea and vomiting after stapedectomy
Subject(s)
Humans , Male , Female , Dexamethasone , Stapes Surgery , Double-Blind Method , PlacebosABSTRACT
Jejunostomy is a common route for enteral nutrition in patient s with upper gastrointestinal [hypopharynx-esophagus] surgery. The aim of this study was to assess the relationship between the starting time of feeding through Jejunostomy with this resulting complications and suggesting a new guideline to reduce complications of the procedure. In a clinical trial study in Amir-Alam hospital patients with upper gastrointestinal malignancy underwent Jejunostomy in a 3 year- period. The patients divided in two groups and complication rates compared feeding through Jejunostomy group [A] 6 hours after the main surgery and group [B] 3 days after the main procedure. Ninety patients [41 male, mean age: 55 yr of age ranging 20-90yr] with upper gastrointestinal malignancy were recruited. In each group twenty seven [30%] of the patients did not complain of any side effect during enteral nutrition .The complications of Jejunostomy procedure in group [A] 6 hours and in group [B] 3 days after the main surgery was seen in 12/37 [32%] and 13/53[24%] of the patients respectively. Significantly higher incidence of abdominal distention and fever was observed in group [A] patients who underwent enteral nutrition through Jejunostomy 6 hours after the main surgery, compared to group [B] [P=0.001] and [P=0.001], respectively. No significant differences in other complications were observed between the two groups. Feeding through Jejunostomy 3 days after the main surgical procedure shows lower adverse effect and because of its well toleration in upper gastrointestinal tract and hypopharyngeal cancer, this method is recommended for enteral nutrition in these patients