[ long-term results of transsternal thymectomy and its related factors in patients with myasthenia gravis presenting at Loghman Hakim hospital in Tehran during 1993-2007: a descriptive study]

Myasthenia gravis is an autoimmune disease characterized by production of autoantibody directly against acetylcholine receptors on postjunctional membranes. The complete removal of the thymus has been the logical goal of operation, but there has been controversy on its relation to long term results. In this study, we try to describe the efficacy of long term result of transsternal thymectomy, and the rate of improvement in patients with myasthenia gravis that presented to Loghman Hakim Hospital, in Tehran, between 1993 and 2007. The study descriptively analyzed all patients with general myasthenia gravis with transsternal thymectomy. At first all patients with myasthenia gravis on the study year's period were found and invited. Efficacy of surgery was studied with dosage of used drug, signs, age, sex, thymus pathology, etc. and was statistically expressed. A maximum of 15 years of postsurgery followup was studied [Mean= 9 yrs]. In study years, 63 patients underwent thymectomy, 48 of whom met the criteria to enroll in our study [76.2%]. Overall, surgical benefit after thymectomy was 77% and 31.2% of the patients were completely cured. In 45.8% of the patients, drug doses were reduced. In 18.7% of the patients drug dose had not changed. In 4.2% of patients, the disease had progressed. Most of the improvement was seen in the first 2 years postthymectomy. Thymectomy is a beneficial treatment modality in patients with generalized myasthenia gravis. The efficacy of transsternal thymectomy for myasthenia gravis had satisfactory results by examining and long-term follow-up of patients. But further investigation in mass population in clinical trials is needed

[Single dose versus triple dose of antibiotic in prophylaxis of wound infection in acute appendicitis: prospective randomized study]

Wound infection is one of the most common problems in surgery and antibiotic usage is one of the ways to prevent it. This Study was performed for six months. All patients who were admitted for acute appendicitis in even days were given single dose of 500mg of metronidazole via IV route and all the patients who were admitted in the odd days were given single dose of 500mg metronidazole via IV route, plus two Separate doses of metronidazole in post operation period. There were 145 patient who were evaluated for this study with 115 male [%79.3] and 30 female [%20.7]. The first group [n=69] were received single dose of metronidazole where the second group [n=76] were received three doses of metronidazole. All patients had not any signs of wound infection. There weren't any meaningful statistical differences for prophylaxis of wound infection between single dose and multiple dose of antibiotic

Gastrointestinal stromal tumors: epidemiology and treatment outcomes

Numerous studies have investigated the prevalence, incidence and clinical manifestations of gastrointestinal stromal tumors [GISTs]. However, little is known about GISTs in Iran. This pioneer study focuses on description of 36 patients with GISTs in Iran. A database was created for 36 patients suffering from GIST who were treated in Loghman Medical Center and Tehran Cancer Institute in Tehran, Iran. Information on age, sex, clinical manifestations, treatment and outcomes were recorded and analyzed using SPSS version 13. Patients had an average age of 60 years; and 16 of them were males. The disease was most commonly manifested by abdominal mass, weight loss, and anemia. Twenty one patients had a mass smaller than 10cm; and in 33 patients KIT test was positive. In the follow-up, 5 patients experienced relapse and 3 succumbed due to advanced cancer. Primary results showed that GISTs might have different manifestations and incidence in Iran compared to other parts of the world. We hope that this study could serve as a starting point for the better understanding and classification of this disease in Iran and for development of improved management strategies

[Aquracy of modified alvardo score in diagnosis of pediatric acute appendicitis in loqman Hospital]

Abdominal pain is one of the most Important and considerable issues in children. One of the most common causes of abdominal pain in children is acute appendicitis. The course of acute appendicitis in children is very faster than adults. Clinical manifestations in Pediatric patients are less typical and are not able to tell the exact history. In addition, no other signs or diagnostic tests can exactly detect the acute appendicitis in Pediatrics. Purpose of this study was the assessment of MAS in diagnosis is of acute appendicitis in Iranian Pediatrics patients. This prospective study was conducted in Loqman Hakim hospital in 1384-5 .Three hundred children aged from 4 to 12 years old with acute abdominal pain were assessed. All of information were taken from their data sheets and pathologic reports and scored in the form of 24 variables [age, sex ...] The results were analyzed via statistic soft ware spss 12 and absolutes score of MAS was counted on the basis of clinical variables. Based on the MAS the patients were divided to 2 groups: the first group were the patients with score of <7 including 147 cases [49 percent]. The second group were the patients the score of 37 Including 153 cases, [51 percent]. In overall, from 300 cases that operated with the suspicious of appendicitis, 269 cases [89.6%] in the pathologic assessment had acute appendicitis. from the patients with score of <7 [147 cases], 124 cases had diagnosis of acute appendicitis [84/35%] from the patients with score of 37 [153 cases], 145 cases had diagnosis of acute appendicitis [94.77%] this outcomes showed no significant difference between these groups in the diagnosis of appendicitis based of this score. According to this analysis, sensitivity of this scoring system in the diagnosis of acute appendicitis was 53.9% and the specificity was 74.19% showing the MAS in diagnosis of acute appendicitis in Iranian pediatric patients is not soley effective and can't be an absolute clue and should be progressed in sensitivity and specificity

Gastric pull-up reconstruction for pharyngolaryngoesophagectomy in head and neck cancer and cervical esophageal squamous cell carcinoma

There are many techniques for reconstruction after total pharyngolaryngoesophagectomy. The use of a transposed stomach to restore gastrointestinal continuity, and this combined cervical and abdominal approach for pharyngolaryngoesophagectomy and gastric pull up has become one of the most popular. This retrospective study is a review of 50 consecutive Iranian patients who underwent pharyngolaryngoesophagectomy and gastric pull up in Amir-Alam Hospital affiliated to Tehran University of Medical Sciences, to determine the complication and survival rates. The clinical data of 50 consecutive cases of cervical esophagus carcinoma and squamous cell carcinoma of the hypopharynx treated by pharyngolaryngoesophagectomy and gastric pull-up were analysed. The age, gender, operating room time, operative mortality, major postoperative complications and survival rate were retrieved. Survival time was studied using Kaplan-Meier method. The postoperative complications were wound infection in five patients, pulmonary complications in ten, Stomal stenosis in six, cutaneous fistula in four, Gastric outlet obstruction in three. There were no intraoperative deaths. One month mortality was 10 per cent. The median survival for patients who underwent pharyngolaryngoesophagectomy and gastric pull-up procedures was 21 months and the 5-year survival was 18%

[Accuracy assessment of laparoscopic examination of intra-abdominal organs in trauma victims]

Performing traditional autopsy mostly seems to be unpleasant in dead persons' relatives' opinion. This study aimed to determine the accuracy of laparoscopic examination of intra abdominal organs in comparison to the traditional autopsy in trauma victims. From December 2004 to September 2005, 50 fresh cadavers of blunt trauma victims were studied in less than 24 hours from death time. Intraperitoneal and retroperitoneal organs were first evaluated by laparoscope and then the traditional autopsy was performed as gold standard. The organs were assessed regarding impairment and its grade in both ways. Diagnostic accuracy of laparoscope was determined for each case with 95% confidence interval using Fisher's exact test. The values of overall and distinct accuracy of laparoscopic examination for intraperitoneal and retroperitoneal organs were significantly comparable with traditional autopsy. The accuracy of laparoscopic evaluation of intraperitoneal and retroperitoneal organs were 90% [95% CI of 81.7% to 94.8%] and 92% [95% CI of 84.7% to 96%] respectively in comparison to open autopsy. The overall accuracy of laparoscopic examination was 84% [95% CI of 74.3% to 90.5%]. The sensitivity and specificity of laparoscopic examination for intraperitoneal but not retroperitoneal organs were acceptable in comparison to open autopsy. Laparoscopic examination seems to be an eligible substitute for the traditional autopsy in assessment of intraperitonel organs