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Background: Allocation of the new (expensive) drugs for difficult refractory diseases and financial protection of the patients is an important challenge in the national health systems worldwide especially in developing countries. Trastuzumab (Herceptin) as one of the effective but expensive drugs, put major financial burden for the Iranian patients and government. So the Ministry of Health and Medical Education (MOHME), decided to implement a national program for appropriate management of breast cancer and regulation of Trastuzumab in I.R of Iran (NPMBCT). In this policy brief we evaluated this issue and provided necessary recommendations. Methods: We designed a conceptual model consisting of the goals, main and supporting processes for management of Trastuzumab in the national program. Five macro-processes selected as the main concerns. Then an expert panel including different scientific disciplines discussed the different aspects of the issue and provided the necessary recommendations. We determined the link between the suggested recommendations and the objectives of the program. Results: Based on the five selected main processes, the experts provided 10 recommendations including: 1) balance in the resource allocation, 2) appropriate modeling for the subsides allocation, 3) avoiding "poor subsidize the rich" phenomenon, 4) development and updating the clinical guidelines, 5) cost-effectiveness analysis on accepted guideline, 6) Quality improvement of diagnostic tests, 7) standardization of the laboratory kits, 8) brand management and lowering the drug cost, 9) improving the patient registry system by ICT infra-structure, 10) development of expert systems to empower the diagnostic laboratories. Conclusion: Given these recommendations, the NPMBCT program will be a successful model for the appropriate management of the expensive drugs and treatment of breast cancer in I.R. of Iran and other developing countries. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced nausea (CIN) in the anticipatory and acute phase is the most common side effect in cancer therapy. The purpose of this study was to investigate the effect of ginger capsules on the alleviation of this problem. Methods: This randomized, double-blind, placebo-controlled clinical trial was performed on 80 women with breast cancer between August till December 2009 in Imam Khomeini Hospital, Tehran, Iran. These patients underwent one-day chemotherapy regime and suffering from chemotherapy-induced nausea. After obtaining written consent, samples were randomly assigned into intervention and control groups. Two groups were matched based on the age and emetic effects of chemotherapy drugs used. The intervention group received ginger capsules (250 mg, orally) four times a day (1 gr/d) and the same samples from the placebo group received starch capsules (250 mg, orally) for three days before to three days after chemotherapy. To measure the effect of capsules a three-part questionnaire was used, so the samples filled every night out these tools. After collecting the information, the gathered data were analyzed by statistical tests like Fisher's exact, Kruskal-Wallis and Chi-square using version 8 of STATA software. Results: The mean±SD of age in the intervention and placebo groups were 41.8±8.4 and 45.1±10 years, respectively. Results indicated that the severity and number of nausea in the anticipatory phase were significantly lower in the ginger group compared with placebo group (P=0.0008, P=0.0007, respectively). Also, the intensity (P=0.0001) and number (P=0.0001) of nausea in the acute phase were significantly lower in the ginger group. On the other hand, taking ginger capsules compared with placebo did not result in any major complications. Conclusion: Consuming ginger root powder capsules (1 gr/d) from three days before chemotherapy till three days after it in combination with the standard anti-emetic regimen can help to reduce the anticipatory and acute nausea. [ABSTRACT FROM AUTHOR]

Background: Delayed nausea (24 to 72 hours after chemotherapy) is one of the most common side effects of chemotherapy. This study investigated the effects of ginger capsules on this problem. Methods: This randomized, double-blind, placebo-controlled clinical trial was performed in Imam Khomeini Hospital (Tehran, Iran) during August-December 2009. It included 80 women with breast cancer undergoing one-day chemotherapy periods and suffering from chemotherapy-induced nausea. After obtaining written consent, the subjects were randomly assigned to intervention and control groups. The two groups were matched in terms of age and emetic effects of chemotherapy drugs. The intervention group received 250 mg ginger capsules four times a day (1 g/day) from three days before to three days after chemotherapy. The control group received 25 mg starch capsules in the same order. To measure the effects of capsules, the patients were asked to fill out a three-part questionnaire every night. The collected data was analyzed with Fisher's exact, Kruskal-Wallis, and chi-square tests using STATA8. Findings: There was no significant difference between the mean duration of the disease between the intervention and control groups (4.2 ± 2.4 vs. 4.5 ± 2.6; P = 0.60). The mean age of subjects in the intervention and control groups was 41.8 ± 8.4 and 45.1 ± 10.0 years old (P = 0.10). The severity and frequency of delayed nausea were significantly lower in patients receiving ginger (P < 0.01 for both). Moreover, taking ginger capsules did not result in any complications compared to placebo (P = 0.50). Conclusion: Taking ginger powder capsules (1 g/day) three days before to three days after chemotherapy besides the standard anti-emetic regimen could reduce the severity and frequency of chemotherapy-induced nausea. [ABSTRACT FROM AUTHOR]

Background and purpose: Incidence of neuroendocrine tumors is increasing in the world. These tumors have a high complexity in clinical presentation, tumor stage and grade. In addition, using markers such as Ki67 level could help in estimating the grade of the tumor. The purpose of this study was to assess the hospital prevalence of neuroendocrine tumors, their origin and association between pathology and immunohistochemistry with Ki67 level. Materials and methods: All patients' records (2004-2010) were reviewed to select patients with neuroendocrine diagnosis, then their pathology and histochemistry samples were reexamined. Patients' demographic characteristics in addition to type, grade and origin of tumors were recorded in a check list. Results: Incidence of neuroendocrine tumors was 8 in 1000 patients. A total of 189 patients including 52.9% male and 47.1% female were found with neuroendocrine tumor diagnosis whose mean age was 49.6 years. Pathology diagnoses were carcinoid (27%), round cell tumor (21.2%) and undifferentiated carcinoma (18.5%). The mean levels of Ki67 were significantly different according to tumor grade, location, necrosis, pathology and immunohistochemistry. Conclusion: This study showed the benefits of Ki67 marker in diagnosing and determining tumor status, thereby helpful in choosing the type of treatment. [ABSTRACT FROM AUTHOR]

Background: Vomiting is one of the most prevalent side effects of chemotherapy in cancer patients. The aim of this study was to evaluate the effect of ginger plant on chemotherapy-induced vomiting, since the previous studies were somehow imperfect and have provided controversial results. Materials and Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 80 women with breast cancer undergoing chemotherapy and suffering from vomiting in Imam Khomeini Hospital, Tehran, Iran, between July and December 2009. During a convenience sampling the participants were randomly allocated into treatment and placebo groups after taking a written informed consent. Two groups were matched based on the age and emetic risk of chemotherapy drugs. The treatment group received 250 mg ginger powder capsules (Zintoma) and placebo group 250 mg starch capsules 4 times a day (1 g/day) for 6 days since 3 days before chemotherapy session. A two-part self-made questionnaire was used to assess the effect of ginger. Patients completed the instrument every day. Then by STATA software version 8, the gathered data were analyzed using Fisher's exact, Kruskal-Wallis, and Chi-square tests. Results: The 2 groups had no significant age differences and were matched (ginger: 41.8±8.4 vs placebo: 45.1±10, P = 0.1). Vomiting cases were significantly lower in ginger group at anticipatory (P = 0.04), acute (P = 0.04), and delayed (P = 0.003) phases. Also, heartburn was the only and venial reported side effect (P > 0.05). Conclusions: Taking ginger capsules (for 6 days since 3 days before chemotherapy) accompanied by the routine antiemetic treatment could relieve chemotherapy-induced vomiting in all phases. [ABSTRACT FROM AUTHOR]

Malignant transformation in a mature cystic teratoma of the ovary is rare. The most common malignancy is squamous cell carcinoma, which consists of about 75% of malignant transformations. In the present report, we describe a case of advanced-stage squamous cell carcinoma arising in a mature cystic teratoma. A postmenopausal 63-year-old woman with squamous cell carcinoma arising in a mature cystic teratoma is presented. The initial investigation by ultrasound showed a left adnexal mass with mixed echo pattern, which arose the suspension of malignancy. She underwent a laparotomy and left oophorectomy. Histopatholog was compatible with squamous cell carcinoma arising in a mature cystic teratoma. After a few episodes of intestinal obstruction and colostomy, she underwent partial resection of the ileum and sigmoid colon four months after the initial oophorectomy. Histopathologic study showed metastatic poorly-differentiated squamous cell carcinoma. Subsequently, she underwent two courses of combination chemotherapy with cisplatin, leucovorin, and 5-fluorouracil with no response. She died from progression of the disease nine months after the initial operation. [ABSTRACT FROM AUTHOR]