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Background: Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients. Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4). Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77) Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.

Background: Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients. Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4). Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77) Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: According to the importance of the esophageal cancer problem in northern provinces of Iran, and also high volume of transhiatal esophagectomy operations at Babol university hospitals, this study was conducted to identifying postoperative short term outcomes of transhiatal esophagectomy in patients with esophageal cancer. METHODS: This cross-sectional study was done on 114 patients with diagnosis of esophageal cancer that underwent transhiatal esophagectomy in Babol university hospitals, north of Iran, from 2005 to 2015. The study data were analyzed applying SPSS for windows (version 23), T-test, 2-independent sample chi-square and exact fisher test. FINDINGS: Of 114 patients, 62 of cases (54.4%) was male and 52 of them (45.6%) was female. The mean age of the patients was 62.25year. The most common symptom of the patients was dysphagia (99.1%). Pathologic feature of the tumors was squamous cell carcinoma in 89.5% of cases. The most common postoperative complications were arrhythmia (13.3%) and pleural effusion (10.5%). Mean admission duration was 9.31±2.94 days. Anastomosis site leak occurred in 8 patients (7.1%). In operation and in hospital mortality occurred for 1 cases (0.9%) and 4 cases (3.5%) respectively. CONCLUSION: On the basis of this study, Babol university hospitals has good result for postoperative outcomes of transhiatal esophagectomy comparing with other centers especially about admission time, need for tube thoracostomy, anastomosis site leak rate, and mortality rate.

مقدمه:سرطان مری از بیماری‌های مهلک در دنیا محسوب می‌شود و در ایران به ویژه در شمال کشور، از شیوع بالایی برخوردار است. درمان اصلی این بیماری جراحی است. به دلیل انجام ناگزیر واگوتومی حین ازوفاژکتومی ،انجام یا عدم انجام پیلوروپلاستی یا پیلورومیوتومی به عنوان روشی جهت درناژ پیلور و جلوگیری از تأخیر در تخلیه‌ی معده، در بین جراحان مورد بحث و اختلاف نظر است. هدف از این مطالعه، بررسی عوارض ازوفاژکتومی بدون پیلوروپلاستی یا پیلورومیوتومی بود. روش‌ها:در این مطالعه‌ی آینده‌نگر، میزان عوارض پس از عمل جراحی ازوفاژکتومی بدون پیلورومیوتومی یا پیلوروپلاستی در 50 بیمار مبتلا به سرطان مری بررسی شد. یافته‌ها:از مجموع 50 بیمار 48 درصد زن و 52 درصد مرد و از این بین، 92 درصد مبتلا به SCC (Squamous cell carcinoma) و 8 درصد مبتلا به آدنوکارسینوم بودند. عوارض زودرس پس از عمل جراحی شامل ترشح از محل آناستوموز (2 درصد)، افیوژن پلورال (10 درصد)، پنوموتوراکس (4 درصد)، پنومونی (14 درصد)، آریتمی قلبی (20 درصد)، دلیریوم (4 درصد)، آسیب عصب راجعه (8 درصد) و عوارض دیررس پس از جراحی شامل تأخیر در تخلیه‌ی معده (34 درصد)، GOO (Gastric outlet obstruction) (2 درصد)، سندرم دامپینگ (6 درصد) و تنگی محل آناستوموز (18 درصد) بود. نتیجه‌گیری:با توجه به این که ازوفاژکتومی بدون پیلوروپلاستی عوارض ناشی از ازوفاژکتومی را افزایش نمی‌دهد و با توجه به کوتاه شدن زمان عمل، می‌توان ازوفاژکتومی را بدون پیلوروپلاستی یا پیلورومیوتومی انجام داد.

• Background: Esophagenctomy is the principle treatment for esophageal and gastroesophageal junction malignancies. Postoperative respiratory failure and other respiratory problems like athelectasis and severe hypoxia occur frequently after esophageal cancer surgeries. Such patients mostly need ICU care and mechanical ventilation. The aim of present study was to evaluate mean duration of mechanical ventilation and its predictor factors during esophageal resection in middle and distal esophageal cancers. • Methods: This cross sectional analytic study performed in Al Zahra hospital, Isfahan on medical records of 70 patients with middle and distal esophageal cancer operated by transhiatal method in Department of Thoracic Surgery. Patient’s age, sex, tumor location, duration of mechanical ventilation, duration of operation, spirometry findings (FEV1), weight loss, need for transfusion, and serum albumin level on admission extracted from medical charts. Finally all data were analyzed by SPSS16 using chi-square and t tests. • Finding: Patient’s mean age was 60.71 ± 11.81 years and 64.3% of them were men. Pathologically, 43 patients (61.4%) and 26 patients (37.1%) were diagnosed by SCC and adenocarcinoma respectively. Totally frequency of complications were 41.4%, and 7.1% of subjects were died within first 30 days. 15 patients (21.4%) were mechanically ventilated after surgery with mean duration of 1.34 day. Mean duration of mechanical ventilation showed no association with intraoperative pleural rapture, intraoperative blood transfusion, anastomosis leakage, type of pathology, postoperative anastomotic stricture, and empyema. However mean duration of mechanical ventilation were significantly higher in died patients within 30 days after surgery, reintubated subjects, patients with serum albumin level of less than 3.5 g/dl, and patients with less than 2 liter FEV1. Among quantitative variables, only FEV1 were associated with mean duration of mechanical ventilation. • Conclusion: As our data showed hypoalbuminemia (which reflects subsequent malnutrition) and less than 2 liter FEV1 is correlates with prolonged mechanical ventilation (and probably more mortality) it is recommended to improve nutritional condition as well as pulmonary function preoperatively to shortened duration of mechanical ventilation and prohibit mortality rate.

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Esophageal cancer is one of the most lethal diseases in the world. It has a high prevalence in Iran, especially in the Northern provinces. The main treatment of esophageal cancer is surgery. There are two common surgical procedures for its treatment, Transhiatal esophagectomy and transthoracic esophagectomy. The aim of this study was to compare the results of above methods in esophageal cancer."n"nMethods: This cross-sectional study was done on patients with pathologic diagnosis of esophageal cancer that referred to surgery ward of Shahid Beheshti Hospital, in Babol, Iran in 2002-2008. Patients according to the location of tumor and physical status were undergone transhiatal or transthoracic esophagectomy. Demographic and surgical findings were recorded. The patients were matched according to age, sex, weight loss, serum albumin level and hemoglobin concentration in two groups. "n"nResults: Fifty nine percent of patients were under transhiatal esophagectomy and 41% were under transthoracic esophagectomy (n=166). Morbidity did not show significant difference (p=0.636) between transhiatal (42.9%) and transthoracic (47.1%) methods. Duration of surgery (min) in transhiatal method (180.7±35.1) was significantly (p

Background: Nasogastric tube (NG tube) usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases.Methods: This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube; the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound (BS) upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5.Results: After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for placing/replacing the NG tube was the same for both groups. There was no difference in the perioperative death rates between the two groups.Conclusions: We conclude that the routine use of NG tubes after surgery is not recommended for all patients. NG tube should be used according to the specific needs of each patient. This protocol will protect patients from undesired complications.

AbstractBackground and purpose: A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure. The aim of this study was to determine the emptying of the intrathoracic stomach after esophagectomy and cervical esophagogastrostomy with or without pyloromyotomy.Materials and Methods: Between January 2003 and April 2006, in a randomized controlled trial, 30 patients with esophageal carcinoma were randomized to have with or without pyloromyotomy as a gastric emptying procedure for the gastric conduit used for esophageal replacement. Patterns of gastric emptying in the vagotomized intrathoracic stomach were studied using radioisotope techniques. Gastric emptying (GE) was evaluated 8 weeks after the operation. Patients were available for 6 months follow-up.Results: A total of 30 patients were enrolled in this study. Sixty percent (18) were male, and 40% (12) were female. Twenty three patients (76.7%) had squamous cell carcinoma and 7 (23.3%) had adenocarcinoma. Delayed GE was reported in 11 (73.3%) and normal GE in 4 (26.7%) of patients with Pyloromyotomy. Delayed GE was reported in 9 (60%) and normal GE in 6 (40%) of patients without Pyloromyotomy. There were not any significant differences between complications of post surgery in both groups.Conclusion: These findings were showed that esophageal surgery can be don’t add a pyloric drainage procedure in esophagectomy and cervical esophagogastrostomy and that very few patients actually need it.

Differentiated carcinoma of the thyroid occruing within the gland is generally not regarded as an aggressive tumor; however, when the tumor extends beyond the gland's capsule and onto adjacent structures, its prognosis worsens. During the past three decades such locally invasive thyroid cancer has been studied, specifically concerning invasion into the airway. Progress in tracheal operations in the past 20 years has changed remarkably in terms of the operative methods and indications for thyroid carcinoma invading the trachea. Resection and primary reconstruction of the trachea invaded by carcinoma of the thyroid should be done in the absence of extensive metastases when technically, feasible. It offers prolonged palliation, avoidance of suffocation and an opportunity for cure. In carefully selected patient with massive regional involvement, radical excision laryngopharyngoesophagectomy and mediastinal tracheostomy is also appropriate. In this article, management of one patient with intraluminal involvement of trachea by thyroid carcinoma is presented and management of upper aerodigestive tract invasion by thyroid cancer reviewed.

Background: Esophageal cancer is one of the deadliest diseases in the world and in particular, has high prevalence in the north of the Iran. The main treatment for this condition is surgery. Because of necessity of vagotomy during esophagectomy, doing or not doing pyloroplasty or pyloromyotomy as a way to prevent delay in emptying the stomach (pyloric drainage), is controversial among surgeons. The aim of this study was to investigate the effects of esophagectomy without pyloroplasty or pyloromyotomy. Methods: In this prospective study, complications of esophagectomy without pyloromyotomy or pyloroplasty in 50 patients with esophageal cancer were reviewed. Findings: 50 patients, 24 women and 26 men, were enrolled, 92% with squamous cell carcinoma (SCC) and 8% with adenocarcinoma. Postoperative early complications included anastomosis leakage (2%), pleural effusion (10%), pneumothorax (4%), pneumonia (14%), cardiac arrhythmias (20%), delirium (4%), and recurrent nerve injury (8%). Late complications after surgery including delayed gastric emptying (34%), gastric outlet obstruction (GOO) (2%), dumping syndrome (6%), and anastomsis stenosis (18%). Conclusion: Based on our findings, esophagectomy without pyloroplasty not only did not increase the complications, but also could shorten the operation time. Therefore, esophagectomy can be performed without pyloroplasty or pyloromyotomy. [ABSTRACT FROM AUTHOR]

Backgrounds and Objectives: Laparoscopic Esophagectomy, as a well established method, has been performed since 2000. Minimally invasive esophagectomy could be done in two methods: the Laparoscopic Transhiatal Esophagectomy (LTS) with cervical incision or the laparoscopic gastric release with thoracoscopic esophageal release. Material and Methods: From July 2011 to September 2012, we started to implement the distal esophageal cancer surgery with LTS method in those who had no metastasis or adhesion bound with no contraindications for surgery, and then we analyze the collected data. Results: 7 men and 4 women were operated. The mean age of study was 65.7±9.1 years. The mean of operative time was 40±154 minutes. The mean postoperative intensive care unit stay and total hospital stay were 2.72±1.95 days and 10.55± 4.80 days, respectively. The cervical anastomosis (n=1) and post-operative pneumonia was the complication of this study; both of them managed medically. Oral feeding was started on third postoperative day in all of our cases. No mortality was observed. Conclusion: Short-term results of our first series of LTS were comparable with previous reports. [ABSTRACT FROM AUTHOR]

Background: Esophagenctomy is the principle treatment for esophageal and gastroesophageal junction malignancies. Postoperative respiratory failure and other respiratory problems like athelectasis and severe hypoxia occur frequently after esophageal cancer surgeries. Such patients mostly need ICU care and mechanical ventilation. The aim of present study was to evaluate mean duration of mechanical ventilation and its predictor factors during esophageal resection in middle and distal esophageal cancers. Methods: This cross sectional analytic study performed in Al Zahra hospital, Isfahan on medical records of 70 patients with middle and distal esophageal cancer operated by transhiatal method in Department of Thoracic Surgery. Patient's age, sex, tumor location, duration of mechanical ventilation, duration of operation, spirometry findings (FEV1), weight loss, need for transfusion, and serum albumin level on admission extracted from medical charts. Finally all data were analyzed by SPSS16 using chi-square and t tests. Findings: Patient's mean age was 60.71 ± 11.81 years and 64.3% of them were men. Pathologically, 43 patients (61.4%) and 26 patients (37.1%) were diagnosed by SCC and adenocarcinoma respectively. Totally frequency of complications were 41.4%, and 7.1% of subjects were died within first 30 days. 15 patients (21.4%) were mechanically ventilated after surgery with mean duration of 1.34 day. Mean duration of mechanical ventilation showed no association with intraoperative pleural rapture, intraoperative blood transfusion, anastomosis leakage, type of pathology, postoperative anastomotic stricture, and empyema. However mean duration of mechanical ventilation were significantly higher in died patients within 30 days after surgery, reintubated subjects, patients with serum albumin level of less than 3.5 g/dl, and patients with less than 2 liter FEV1. Among quantitative variables, only FEV1 were associated with mean duration of mechanical ventilation. Conclusion: As our data showed hypoalbuminemia (which reflects subsequent malnutrition) and less than 2 liter FEV1 is correlates with prolonged mechanical ventilation (and probably more mortality) it is recommended to improve nutritional condition as well as pulmonary function preoperatively to shortened duration of mechanical ventilation and prohibit mortality rate. [ABSTRACT FROM AUTHOR]