Correlates of Lymphedema in Women with Breast Cancer: a Case Control Study in Shiraz, Southern Iran.

Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was 52.3±11.0 years and of the control group was 50.1±10.9 years. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was 4.4±2.5 cm and the difference in volume displacement was 528.7±374.4 milliliters. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI: 2.6-73.3 ), invasiveness of BC (OR =13.7, 95% CI: 7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI: 2.3-7.9), BMI =>25 (OR=4.2, 95% CI: 2-8.7), radiotherapy (OR=3.9, 95% CI: 1.8-8.2 ), past history of limb damage (OR=1.7, 95% CI: 0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI: 1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in BC patients to prevent development of BCRL and improve QOL of these patients.

Comparing the impact of intraperitoneal hydrocortisone with bupivacaine on postoperative pain after laparoscopic cholecystectomy.

BACKGROUND: Postoperative pain is a major complaint following laparoscopic cholecystectomy. OBJECTIVES: The aim of this study was to compare the impact of intraperitoneal hydrocortisone with intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomy. PATIENTS AND METHODS: In a double blind clinical trial, 63 candidates for laparoscopic cholecystectomy were randomly allocated to receive intraperitoneal instillation of either 100 mg bupivacaine in 250 mL normal saline (n = 32) or 100 mg hydrocortisone in 250 mL normal saline (n = 31) before insufflation of CO2 into the peritoneum for postoperative pain relief. Patients were investigated regarding abdominal and shoulder pain using (visual analog scale) VAS in recovery room and at 6, 12 and 24 hours postoperatively. Patients were also followed regarding postoperative analgesic requirements, nausea and vomiting, and return of bowel function. RESULTS: Sixty patients completed the study. Patients in the hydrocortisone group had no statistically significant abdominal and shoulder pain scores compared to the bupivacaine group. The patients were similar regarding postoperative analgesic requirements, return of bowel function, nausea and vomiting. No adverse effect was detected in either group. CONCLUSIONS: Intraperitoneal administration of hydrocortisone is as effective as bupivacaine to reduce pain and analgesic requirements after laparoscopic cholecystectomy.

Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain.

BACKGROUND: Gasretention in the peritoneal cavity plays an important role in inducing postoperative pain after laparoscopy, which is inevitably retained in the peritoneal cavity. OBJECTIVES: The aim of this study was to detect the relation between the volume of residual gas and severity of shoulder and abdominal pain. PATIENTS AND METHODS: In this Prospective study 55 women who were referred for laparoscopic cholecystectomy, were evaluated for the effect of residual pneumoperitoneum on postlaparoscopic cholecystectomy pain intensity. The pneumoperitoneum was graded as absent, mild (1-5 mm), moderate (6-10 mm) and severe (> 11 mm). Patients were followed for postoperative abdominal and shoulder pain using visual analogue scale (VAS), postoperative analgesic requirements, presence of nausea and vomiting, time of unassisted ambulation, time of oral intake and time of return of bowel function in the recovery room and at 6, 12 and 24 hours after operation. RESULTS: At the end of the study, 17 patients (30.9%) had no residual pneumoperitoneum after 24 hours; which 23 (41.81%) had mild residual pneumoperitoneum, eight (14.54%) had moderate pneumoperitoneum and seven (12.72%) had severe pneumoperitoneum. Patients with no or mild residual pneumoperitoneum had significantly lower abdominal and shoulder pain scores than whom with moderate to severe pneumoperitoneum (P = 0.00) and need less meperidine requirements (P = 0.00). Patients did not have any significant difference in time of oral intake, return of bowel function, nausea and vomiting percentages. CONCLUSIONS: We conclude that volume of residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.

Assessment of genitourinary trauma in southeastern iran.

BACKGROUND: To survey genitourinary (GU) organ injury following general trauma, we performed an epidemiologic study of urogenital injuries in trauma patients referred to our hospital (a teaching hospital affiliated with the Zahedan University of Medical Sciences). OBJECTIVES: We aimed to assess the epidemiology of urogenital system injuries in southeastern Iran. PATIENTS AND METHODS: From April 2009 to November 2011, all patients with GU injuries referred to our hospital were studied. The data including age, sex, type of injury, mechanism of trauma, and prognosis of patients was collected and analyzed. RESULTS: From a total of 3450 patients, 66 (1.91%) had injuries of the urogenital system; 49(74.24%) were male and 17(25.75%) female. The patients' mean age was 23 ± 12 years (range 2 to 75 years). Of these 66 patients, 61 (94.24%) had blunt trauma, and 5 (7.57%) had penetrating trauma. Motor vehicle accidents were the most common cause of trauma (63.63%). The most common injured organs were kidneys in 41 (62.12%) and the bladder in 9 (13.6%); 47 patients (71.21%) had associated intra-abdominal injuries, and 42 (63.63%) had other accompanying injuries; 23(34.84%) patients required surgical intervention. Three patients (4.54%) died due to the severity of injuries (Injury Severity Score > 12). CONCLUSIONS: In our assessment, blunt trauma including road traffic accidents were the main cause of urogenital injuries. Most patients with urogenital trauma had multiple injuries, and required a multidisciplinary approach for management.

Amputation: a ten-year survey.

BACKGROUND: Limb loss occurs due to different causes and has been increased in many countries. It has without exception, great economic, psychological and social impacts. OBJECTIVES: This study assesses the demographics of amputees in one city of Iran. PATIENTS AND METHODS: This retrospective study was undertaken on all of the amputees between April 2002 and December 2011. Patients' demographics including age, sex, the amputated limb, etiology of limb loss and level of amputation were recorded. RESULTS: We had 216 patients in the study. The average number of amputations was 21.6 per year and varied from 14 to 32. The mean age of amputation was 39.26± 12.6 years. Of the patients, 172 were male (79.62%) and 44 female (20.37%); 119 of the amputations (55.09 %) were major and 97 minor (44.9 %). The most common cause of amputation was trauma and the most common was the toe. In trauma patients the mean age was 38.12± 10.25 years and 98 (83.7%) were male. CONCLUSIONS: In contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations. Results of this study may be used in prevention planning.

Prognostic Factors for Fournier's Gangrene; A 10-year Experience in Southeastern Iran.

OBJECTIVES: To describe the characteristics and prognostic factors of 28 patients with Fournier's Gangrene (FG) referred to our medical center at Southeastern Iran. METHODS: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical Sciences during a 10-year period from April 2002 to March 2012. The study analyzed 9 parameters including the body temperature, heart rate, respiratory rate, hematocrit, white blood count (WBC), and serum levels of sodium, potassium, creatininee (twice for 2 for acute renal failure), and bicarbonate for Fournier Gangrene Severity Index (FGSI) score. The aspects taken into account were age, gender, predisposing factors, duration of symptoms, hospitalization period, and number of debridements, disease outcome and the FGSI. RESULTS: All patients were males, aged from 26 to 68 years, with mean age 44.6 ±8.49 years. Statistically significant differences in age (p<0.001), duration of symptoms (p=0.001), number of debridements (p=0.006), hospitalization duration (p<0.001) and FGSI (p<0.001) were found between surviving and dead patients. The mortality rate was 35.7%, and the most common presentation was perianal/scrotal pain (78.6%). Perianal and primary scrotal abscesses were most common causes of FG and were found in 57.14% and 21.42% of patients respectively. The most prevalent predisposing factor was diabetes mellitus in 12 (42.85%) patients. With respect to laboratory findings, statistically significant differences in WBC (p=0.002), creatinine (p<0.001), albumin (p<0.001), calcium (p<0.001) and serum sodium (p=0.035) were found between the surviving and dead patients. CONCLUSION: Serious outcome of FG was associated with old age, delayed diagnosis and treatment, inadequate surgical debridement, shorter hospitalization and higher FGSI scores. In addition higher WBC, higher creatininee and serum sodium and lower albumin and calcium levels implicated worse prognosis.