Esophagitis may not be a Major Precursor Lesion for Esophageal Squamous Cell Carcinoma in a High Incidence Area in North-Eastern Iran.

BACKGROUND Esophageal squamous cell carcinoma (ESCC) is usually detected in advanced stages resulting in a very poor prognosis. Early diagnosis needs identification of clinically relevant precancerous lesions which could become the target of screening and early treatment. Our aim was to check whether esophagitis could serve as a relevant histological precursor of ESCC in Northern Iran. METHODS During 2001-2005, all adult patients who were referred to Atrak clinic for upper gastrointestinal endoscopy and biopsy were enrolled. Atrak clinic is a major center for upper gastrointestinal cancer research in eastern Golestan. All subjects had been complaining of upper GI symptoms and were under further investigation to rule out cancer. Biopsies from the endoscopically normal mid-esophagus and also just above the esophago-gastric junction were obtained in all subjects whose esophagus appeared normal during endoscopy and from endoscopically normal appearing mucosa at the proximal vicinity of any detected mass. Microscopic examinations for the verification of the presence or absence of esophagitis was performed by independant histological examination of the samples by two pathologists. All the discrepant diagnoses were resolved in joint diagnostic sessions. RESULTS During the study period 836 patients were enrolled including 419 non cancer patients (endoscopy clinic controls), 387 cancer patients, and 30 subjects with clinical diagnosis of malignancy referred for histological reconfirmation of diagnosis by repeated biopsy. Mild or marked mid-esophagitis was diagnosed in 39 (9.3%), 47 (12.5%) and 12 (40%) of endoscopy clinic controls, cancer patients and those who were suspicious for upper gastrointestinal malignancies. CONCLUSION Our observation does not show evidence for esophagitis to be a predisposing factor for ESCC in Gonbad region In North Eastern Iran.

Influence of dietary fat source and supplementary α-tocopheryl acetate on pulmonary hypertension and lipid peroxidation in broilers.

An experiment was conducted to examine pulmonary hypertension and lipid peroxidation of broilers as affected by dietary fat source and α-tocopheryl acetate. Two hundred and forty day-old male chicks were used in a completely randomized design with five treatments consisted of four replicates and 12 chicks per replicate. Treatments included a control group that received no supplemental fat (treatment 1) or groups that received diets supplemented with beef tallow, soybean oil, a 50:50 blend of beef tallow and soybean oil, or soybean oil plus α-tocopheryl acetate added at 220 mg/kg (treatments 2 to 5). All diets were kept isoenergetic and isonitrogenous and diet treatments 2 to 5 had 50 g/kg of fat supplement. Results showed that weight gain and feed consumption were significantly (p ≤ 0.05) increased by adding fat to the diet during the starter stage. However, birds that received fat-supplemented diets gained less (p ≤ 0.05) during the grower period. Serum malone dialdehyde concentration and glutathione peroxidase activity were not affected by dietary treatments with the exception that inclusion of α-tocopheryl acetate to the diet supplemented with soybean oil significantly (p < 0.05) reduced the activity of the enzyme when measured at 21 days of age. The relative weights of heart and liver and the right ventricle weight to total ventricle weight ratio were greater in broilers fed fat-supplemented diets (p < 0.05).

Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer.

BACKGROUND: A pilot study was carried out to evaluate validity and reproducibility of a food frequency questionnaire (FFQ), which was designed to be used in a prospective cohort study in a population at high risk for esophageal cancer in northern Iran. METHODS: The FFQ was administered four times to 131 subjects, aged 35-65 years, of both sexes. Twelve 24-h dietary recalls for two consecutive days were administered monthly during 1 year and used as a reference method. The excretion of nitrogen was measured on four 24-h urine samples, and plasma levels of beta-carotene, retinol, vitamin C and alpha-tocopherol was measured from two time points. Relative validity of FFQ and 24-h diet recall was assessed by comparing nutrient intake derived from both methods with the urinary nitrogen and plasma levels of beta-carotene, retinol, vitamin C and alpha-tocopherol. RESULTS: Correlation coefficients comparing energy and nutrients intake based on the mean of the four FFQ and the mean of twelve 24-h diet recalls were 0.75 for total energy, 0.75 for carbohydrates, 0.76 for proteins and 0.65 for fat. Correlation coefficients between the FFQ-based intake and serum levels of beta-carotene, retinol, vitamin C and vitamin E/alpha-tocopherol were 0.37, 0.32, 0.35 and 0.06, respectively. Correlation coefficients between urinary nitrogen and FFQ-based protein intake ranged from 0.23 to 0.35. Intraclass correlation coefficients used to measure reproducibility of FFQ ranged from 0.66 to 0.89. CONCLUSION: We found that the FFQ provides valid and reliable measurements of habitual intake for energy and most of the nutrients studied.

Golestan cohort study of oesophageal cancer: feasibility and first results.

To investigate the incidence of oesophageal cancer (EC) in the Golestan province of North-East Iran, we invited 1349 rural and urban inhabitants of Golestan province aged 35-80 to undergo extensive lifestyle interviews and to provide biological samples. The interview was repeated on a subset of 130 participants to assess reliability of questionnaire and medical information. Temperature at which tea was consumed was measured on two occasions by 110 subjects. Samples of rice, wheat and sorghum were tested for fumonisin contamination. An active follow-up was carried out after 6 and 12 months. A total of 1057 subjects (610 women and 447 men) participated in this feasibility study (78.4% participation rate). Cigarette smoking, opium and alcohol use were reported by 163 (13.8%), 93 (8.8%) and 39 (3.7%) subjects, respectively. Tobacco smoking was correlated with urinary cotinine (kappa = 0.74). Most questionnaire data had kappa > 0.7 in repeat measurements; tea temperature measurement was reliable (kappa = 0.71). No fumonisins were detected in the samples analysed. During the follow-up six subjects were lost (0.6%), two subjects developed EC (one dead, one alive); in all, 13 subjects died (with cause of death known for 11, 84.6%). Conducting a cohort study in Golestan is feasible with reliable information obtained for suspected risk factors; participants can be followed up for EC incidence and mortality.

Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran.

Previous studies have shown that oesophageal and gastric cancers are the most common causes of cancer death in the Golestan Province, Iran. In 2001, we established Atrak Clinic, a referral clinic for gastrointestinal (GI) diseases in Gonbad, the major city of eastern Golestan, which has permitted, for the first time in this region, endoscopic localisation and histologic examination of upper GI cancers. Among the initial 682 patients seen at Atrak Clinic, 370 were confirmed histologically to have cancer, including 223 (60%) oesophageal squamous cell cancers (ESCC), 22 (6%) oesophageal adenocarcinomas (EAC), 58 (16%) gastric cardia adenocarcinomas (GCA), and 58 (16%) gastric noncardia adenocarcinomas. The proportional occurrence of these four main site-cell type subdivisions of upper GI cancers in Golestan is similar to that seen in Linxian, China, another area of high ESCC incidence, and is markedly different from the current proportions in many Western countries. Questioning of patients about exposure to some known and suspected risk factors for squamous cell oesophageal cancer confirmed a negligible history of consumption of alcohol, little use of cigarettes or nass (tobacco, lime and ash), and a low intake of opium, suggesting that the high rates of ESCC seen in northeastern Iran must have other important risk factors that remain speculative or unknown. Further studies are needed to define more precisely the patterns of upper GI cancer incidence, to test other previously suspected risk factors, and to find new significant risk factors in this high-risk area.

Endoscopic esophageal cancer survey in the western part of the Caspian Littoral.

After a hiatus of 30 years an attempt is now being made to re-assess the previously reported very high esophageal cancer incidence rates in the Caspian Littoral. The extraordinarily high incidence rates found in the eastern side of the Littoral, were re-confirmed five years ago for the Turkoman region, using esophageal balloon cytology supplemented by esophagoscopy of suspected cases. The focus this time was on the Ardabil province in the western side of the Caspian Littoral, where the rates reported 30 years ago were moderately high. A pilot chromoendoscopic screening program was scheduled for 650 asymptomatic adults from a randomly selected part of the city of Ardabil and adjoining villages, to evaluate the overall patterns of esophageal disease and to establish the utility of endoscopy as an esophageal cancer screening tool. 504 healthy volunteers, giving a compliance rate of 77.5%, submitted to esophagogastroscopy without any mishaps. Contrary to expectation, no dysplasia or esophageal cancer was found in 914 satisfactory biopsy specimens. Total absence of esophageal cancer or precursor dysplastic changes in the surveyed population in the western part of the Caspian Littoral was at variance with the cancer registry findings of three decades ago for the western part of the Littoral. A plausible explanation could be the improved socio-economic conditions and life style changes which have taken place in the recent past all along the Caspian Littoral, except in the Turkoman Plain.

Oesophageal cancer among the Turkomans of northeast Iran.

A Caspian Littoral Cancer Registry survey in the early 1970s established northern Iran as one of the highest oesophageal cancer incidence regions of the world. To verify this, an oesophageal cancer survey was carried out between 1995 and 1997 in the Turkoman Plain at the southeastern corner of the Caspian Sea. Oesophageal balloon cytology screening was carried out on 4192 asymptomatic adults above age 30 years in one town and three adjoining villages with a total population of 20 392 people at risk. Oesophagoscopy was performed on 183 patients with abnormal cytological findings. The discovery of two asymptomatic small squamous cell cancers and one 'carcinoma- suspect' implied a prevalence ranging from 47.7 per 100 000 to 71.5 per 100 000. During a 1-year active surveillance, 14 patients were found with clinically advanced oesophageal squamous cell cancer, yielding age-standardized incidence rates of 144.09 per 100 000 for men and 48.82 per 100 000 for women. The very high frequency of oesophageal cancer reported for northern Iran 25 years ago stands confirmed. Differences in incidence rates, then and now, can be attributed to survey methods used and diagnostic criteria applied, but not to socioeconomic factors, which have remained relatively stable. Oesophageal balloon cytology is a practical method of mass screening for oesophageal cancer in Iran.

[Treatment of acromioclavicular joint dislocation with the Rahmanzadeh joint plate]. / Die Behandlung der akromioklavikulären Luxation mit der Gelenkplatte nach Rahmanzadeh.

Type Tossy III dislocations of the acromioclavicular joint (AC) are treated surgically in German-speaking countries. There is considerable rotation and tilting in the AC joint with elevation or abduction of the shoulder joint over 90 degrees. Thus, in the majority of countless surgical procedures, the abduction and elevation are restricted or immobilized for long periods in abduction strapping or other types of movement restriction. The AC joint plate developed by Prof. Rahmanzadeh enables early functional, complete physical therapy since the plate permits rotation and tilting. Over a period of 13 years, 133 patients have been treated with this plate. 83 patients could be included in the follow-up examination. On the average, the follow-up was 4.8 years after surgery. In the evaluation score according to Taft et al., 76% of the patients in the follow-up showed very good or good results. The surgical procedure is standardized and will show that no immobilization is required postoperatively. It could already be seen of the first postoperative day that patients could passively elevate up to 90 degrees. At the latest, free active abduction and elevation are reached after 5 weeks. Material removal should take place after 12 weeks. Due to the limited tissue covering in the area of the AC joint, a higher rate of infection can be expected than in other osteosyntheses. However, there were no persistent infections. Transitory problems in the implantation were remedied by constructive changes in the course of its development. Rahmanzadeh's AC plate is outstandingly suited for surgical treatment of type Tossy III AC joint injuries and for the treatment of lateral clavicle fractures.

[Surgical treatment of acromioclavicular joint injury]. / Die operative Behandlung der Schultereckgelenksverletzung.

The acromioclavicular joint plate according to Rahmanzadeh allows the safe retention of the reset acromioclavicular joint in stage Tossy III and in exceptional cases also in stage Tossy II traumata when simultaneous early functional post-treatment is done from the first postoperative day on. The clinical results obtained after follow-up examinations of 53 of the 83 patients treated in this way were mostly good or very good. Perfect radiological results were obtained in 50% of these patients; 40% showed a slight subluxation and 10% a marked but pain-free subluxation.