Response rate and toxicity of Docetaxel / Cisplatin /5FU in comparison with cisplatin / 5FU induction chemotherapy in locally advanced head and neck squamous cell carcinoma

Introduction: Response to chemotherapy is a reliable marker for radiation sensitivity in patients with locally advanced head and neck squamous cell carcinoma. We compared the response rate and toxicity after two cycles of chemotherapy using Docetaxel / Cisplatin /5FU or Cisplatin / 5FU among these patients

Materials and Methods: We randomly assigned 16 to 75 years old patients with stage III or IV non-metastatic locally advanced head and neck squamous cell carcinoma to receive either DCF or CF every 3 weeks for two cycles. All patients who received at least one and two cycles of chemotherapy were considered for toxicity and response evaluation respectively

Results: Seventy patients underwent randomization, 36 and 34 patients were assigned to Docetaxel / Cisplatin /5FU and Cisplatin / 5FU groups respectively. Three and 8 patients were excluded after randomization and before receiving any chemotherapy in Docetaxel / Cisplatin /5FU and Cisplatin / 5FU groups respectively. Finally 30 and 25 in Docetaxel / Cisplatin /5FU group and 25 and 23 patients in Cisplatin / 5FU group were evaluated for toxicity and response respectively. Response rate [complete and partial response] was%83 [35% complete and 48% partial response] and%84[16% complete and 68% partial response] in Cisplatin / 5FU and Docetaxel / Cisplatin /5FU groups respectively [P= 0.28]. There was no differences in complete response rate between two groups [P=0.18]. Neutropenia, phlebitis and mucositis were more common in Cisplatin / 5FU group without statistically significant difference. Constipation was significantly more common in Cisplatin / 5FU group [P= 0.008]. Diarrhea, alopecia and febrile neutropenia were significantly more common in Docetaxel / Cisplatin /5FU group [P= 0.006, 0.01 and 0.03 respectivly]

Conclusion: We could not find any significant differences between response to Docetaxel / Cisplatin /5FU and Cisplatin /5FU combination chemotherapy among Iranian patients with locally advanced head and neck squamous cell carcinoma. However, for better evaluation, larger studies with better designs are being conducted in our center

Comparison of doppler ultrasonographic findings in complicated and uncomplicated lower-limb varicose veins

Comparing anatomicopathologic findings in complicated and uncomplicated lower-limb varicose veins by ultrasonography. Totally, 231 consecutive patients [148 [64%] men; mean age, 46.8 +/- 14.3 years [range: 16-88 years]]; 155 [54%] left and 132 [46%] right variceal legs were evaluated by Doppler ultrasonography with color-flow imaging using a 7.5-10 MHZ linear probe. The lower extremity venous system [including perforators and valves] were evaluated in the supine and standing position, at rest and during Valsalva's maneuver. Chi square and Fischer's exact tests were used for statistical analysis. We also performed a logistic regression analysis considering presence of any type of complication as the dependent variable and anatomic pathologies as independent variables. Of the 287 limbs with varicose veins, 124 [43%] had at least one complication [ulceration, pigmentation or infection]. The highest complication rate was seen simultaneously with chronic deep vein thrombosis [DVT] with segmental obstruction [76.9] and the lowest complication rate in the incompetent valves was seen in patients with perforan vein reflux [50.4%]. Mostly, the complication rate was higher in patients with the pathology in comparison to patients without it [p values<0.005]. In a multivariate logistic regression model, presence of DVT and saphenofemoral incompetency were statistically significant in the model in comparison to other pathologies [OR=10.6 and 7, respectively, p values<0.02]. In 175 patients [75.8%] one of the legs were involved Presence of ulcer, pigmentation and infection are significantly associated with a higher incidence of DVT, deep vein, saphenofemoral and saphenopopliteal incompetency in patients with lower limb varices

Diagnostic accuracy of Multi-Slice Computed Tomographic [MSCT] angiography in the detection of cerebral aneurysms

Multislice computed tomographic [MSCT] angiography is a rapid and minimally invasive method for the detection of intracranial aneurysms. The purpose of this study was to compare MSCT angiography with digital subtraction angiography [DSA] in the diagnosis of cerebral aneurysms. In this cross sectional study we evaluated 111 consecutive patients [42[37.8%] male and 69[62.2%] female], who were dmitted under clinical symptoms and signs, suggestive of harboring an intracranial aneurysm by using a four detector MSCT angiography. Then we compared results of MSCT angiography with DSA results as a gold standard method. DSA was performed by bilateral selective common carotid artery injections and either unilateral or bilateral vertebral artery injections, as necessary. MSCT angiography images were interpreted by one radiologist and DSA was performed by another radiologist who was blinded to the interpretation of the MSCT angiograms. The mean +/- SD age of the patients was 49.1 +/- 13.6 years [range: 12-84 years]. We performed MSCT in 111 and DSA in 85 patients. the sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive and negative likelihood ratio [LR] of MSCT angiography, when compared with DSA as the gold standard, were 100%, 90%, 87.5%, 100%, 10 and 0, respectively. MSCT angiography seems to be an accurate and non-invasive imaging modality in the diagnosis of intracranial aneurysms

Intracranial manifestations of tuberous sclerosis: a pictorial essay

Tuberous sclerosis is an autosomal dominant genetic disease that involves multiple organs. Hamartomas are the predominant lesions. Classically, tuberous sclerosis has been characterized by a classical clinical triad of facial angiofibromas [90%], mental retardation [50-80%], seizure [80-90%] and all three in 30% of the patients. Two major features or one major feature plus two minor features are necessary for the definite diagnosis of this disease. We had some patients admitted with different presentations of tuberous sclerosis and a past history of convulsion from childhood, skin lesions and also mental retardation with a new onset headache and a changed pattern of convulsion. In physical examination, facial angiofibromas and subungual fibromas were apparently detected. Brain CT scan study with contrast showed multiple calcified nodules associated with tubers, ventriculomegaly and also enhancing enlarged nodules at the foramen of Monro, which were suggestive of subependymal giant cell astrocytoma [SGCA]. MRI showed the same brain findings [tubers, white matter lesions and subependymal nodules associated with SGCA], which were detected better. After surgery, SGCA was proved. In abdominal and pelvic CT scan and ultrasonography, massive bilateral angiomyolipomatosis and focal hypodense hyperechoic liver lesions were detected

Prevalence of incidental thyroid nodules diagnosed by ultrasound in an Iranian population

Since Iran is an endemic region for iodine deficiency, we conducted this study to determine the prevalence of incidental thyroid nodules in our university-affiliated hospitals. Four hundred and ten consecutive patients who attended our center for color Doppler ultrasound of carotid or other sites of the neck-other than the thyroid gland-from September 2005 to May 2006 were included in this study. All patients underwent dedicated thyroid ultrasound for detection of thyroid nodules. We found one or more nodules in 210 [51.2%] of our patients. The mean [ +/- SD] age of patients with incidental thyroid nodules was 62.9 +/- B.1 [range: 14-100] years. The nodules were unilateral in 56.5% and bilateral in 43.5% of the patients. Incidental thyroid nodules were detected in 46.9% of men and 58.8% of women [P=0.017]. Among our patients, 61% had only one nodule. The mean [ +/- SD] largest diameter of nodules among those with only one nodule was 10.6 7.9 mm while it was 14.2 11 mm among those with more than one nodule [P=0.03]. The prevalence of thyroid incidentalomas in the population we studied was higher than many other studies. This may be due to iodine deficiency in our country

case report of hepatic artery embolization in patient with carcinoid tumor with multiple liver metastases

Carcinoid tumors arise from neuroendocrine cells throughout the body. Ninety percent of these tumors derived from the kulchitsky cells within the gastrointestinal tract. Metastasis to the liver from this tumor is resistant to chemotherapy. Hepatic artery embolization recommended a method for treatment of these patients. In this study we report the outcome of treatment with hepatic artery embolization in a patient with involvement >75% of liver parenchyma to metastasis. A 32 year old woman with carcinoid tumor of small intestine was admitted to our hospital. CT scan was performed and the patient had multiple liver metastases. After surgery, chemotherapy was performed for the treatment of liver metastasis but the patient showed no response to chemotherapy. Because of severe pain, the patient underwent hepatic artery embolization with polyvinyl alcohol. After two months due to recurrence of RUQ pain, 40cc of ethanol [96%] was injected into liver artery and the pain was relieved. Interventional radiology and hepatic artery embolization with poly vinyl alcohol are not certain methods for treating hypervascular metastatic liver tumor but it is considered as a suitable method for decreasing pain

Large intratumoral pseudoaneurysm in a patient with bleeding renal angiomyolipoma

Angiomyolipoma [AML] is the most common benign renal tumor. It is composed of an abnormal collection of 3 primary components: unusual abdominal blood vessels, clusters of adipocytes and sheets of smooth muscle. CT is the preferred imaging technique for diagnosing and characterizing AMLs. AMLs typically have a benign course, but patients occasionally present with complications, such as sudden pain or hypotension secondary to spontaneous hemorrhage in the tumor. If the patient is symptomatic, the tumor grows rapidly or is >4 cm, angiography and selective arterial embolization or renal-sparing surgical excisions of the tumor are the treatment of choice. Patients with AMLs treated with embolization generally have a favorable outcome

prevalence of carotid artery disease in candidates of coronary artery bypass graft

Patients with concomitant coronary artery disease and carotid artery disease are at risk of developing serious neurologic events in pre- and post-coronary artery bypass graft [CABG] operation. The objective of this study was to determine the carotid Doppler ultrasonography findings in candidates for CABG. Between September 2004 and October 2005, we performed preoperative Doppler study of carotid vessels in all candidates for CABG admitted to our hospital. We evaluated the level of stenosis, and the type, site and nature of the plaque for all patients according to the Nicoladis guideline. Mean +/- SD age of patients studied was 67.5 +/- 8.6 [range: 29.84] years. Among 352 patients undergoing CABG, 143 [40.3%] had carotid disease. Stenosis >50% was observed in 10.5% of females and 5% of males [P=0.07]. Significant stenosis [>/= 50%] was seen in 32 [9.1%] of patients, while 13 [3.8%] had critical stenosis [>/= 70%]; 2 [0.6%] had complete occlusion of the left internal carotid artery. The prevalence of carotid stenosis and atherosclerotic plaques was higher in patients aged >60 years [P=0.002]. The frequency of carotid stenosis in our patients is similar to other reports. Age is the important associated factor for carotid artery disease in candidates of CABG

Embolization for hemorrhagic multiple intrarenal microaneurysms following percutaneous renal biopsy in a patient with systemic lupus erthematosus

Although patients with systemic lupus erythematosus [SLE] have a high incidence of arterial and venous thrombotic manifestations, intrarenal microaneurysms have been quite rarely reported in these patients, and are probably unrecognized. We report a case of SLE which was complicated with huge retroperitoneal hemorrhage due to rupture of pseudoaneurysm following renal biopsy, associated with multiple microaneurysms. On angiography, multiple microaneurysms of the intralobular arteries and bleeding from the lower pole renal pseudoaneurysm were seen, which was embolized with gel foam. This case represents an unusual presentation of SLE