• Asian Pacific Journal of Cancer Prevention
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• v.13 no.4
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• pp.1407-1412
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• 2012

Background & Objectives: Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people > 50 years targeted in a mass screening program in a hot-point region. Methods: Based on the pilot results in Guilan Cancer Registry study (GCRS), one of the high point regions for GC-Lashtenesha- was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. Results: Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of $61.7{\pm}9.0$ years (range: 50-87 years) underwent upper GI endoscopy. H. pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one (0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia (38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. Conclusion: Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for the GC surveillance program at the national level.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3611-3615
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• 2012

Objective: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. Materials and methods: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of < 0.05 was considered as statistically significant. Results: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for introral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. Conclusion: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.177-180
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• 2004

Objectives: To completely excise a malignant tumor which invades carotid artery walls, the resection and reconstruction of the carotid artery is essentially required. In most of the cases, interposition graft using a saphenous vein has been performed, however the vessel caliber discrepancy between a common carotid artery and the saphenous vein can result in a problem on surgical technique. We have introduced and evaluated a new titanium hemoclip tailing method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection in the treatment of head and neck cancers. Method: After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and an orifice of the common carotid artery was gradually reduced to a little larger than or the same size as the orifice of the vein by using the titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein through anastomosis. The same method was also applied to the distal anastomosis site. There after, the vessels were connected through the anastomosis, and a circulation was restored by releasing a vascular clamp. Then, a titanium hemostatic clip-applied redundant portion on the outside of carotid artery was sutured by the blanket edge suture method, using 6-0 Prolene. Results: We have experienced this method in two patients with recurrent squamous cell carcinoma and neuroblostoma, respectively. The interposition saphenous vein graft of these patients was found to maintain good patency on the follow up angiography after one year, and they had no specific vascular complication, such as atherosclerosis. Conclusion: This method made it possible to simply perform the interposition saphenous vein graft (ISVG) within a short time and, therefore, was very useful for shortening the duration to block circulation.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.149-154
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• 1998

We retrospectively analyzed 54 patients with esophageal cancer treated surgically between 1992 and 1996. They composed of 51(94.4%)men, 3(5.6%)women, and the age ranged from 42 to 78, the mean was 58.7$\pm$8.37. Symptoms were varied with dysphagia(72.2%), epigastric discomfort(16.6%), chest pain (5.6%), and so on(5.6%). Transthoracic esophagectomy(TTE) with esophagogastrostomy was done in 36 case, TTE with esophagocologastrostomy in 4 case, and transhiatal esophagectomy(THE) with esophagogastrostomy in 14 case. The operative mortality was 12.9%(7/54); 6 underwent TTE with esophagogastrostomy, and 1 underwent TTE with esophagocologastrostomy. Postoperative complications were of anastomotic leakage in 7 case, wound infection in 10 case, anastomotic stricture in 9 case, vocal cord paralysis in 2 case, bronchial tearing in 1 case, and pneumothorax in 3 case. Locations of esophageal cancer were upper thoracic esophagus in 4 case, middle thoracic esophagus in 34 case and lower thoracic esophagus in 16 case. Histological types were adenocarcinoma in 1 case and squamous cell carcinoma in 53 case. During the follow-up period, 25 cases died. Cumulative survival rate was 52.7% in 1 year, 45.5% in 2 year, 45.5% in 3 year, 45.5% in 4 year, 45.5% in 5 year.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.186-189
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• 1998

Malignant mesenchymoma is a very rare tumor presented during the embryonic and infant period and malignant mesenchymoma in the adult is extremely rare. Tumor is composed of two or more unrelated mesenchymal derivatives apart from fibrous tissue. These tumors are thought to be originated from embryonic mesenchyme capable of differentiating into any type of connective tissue. A 61 years old man with complaints of cough and copious sputum of onset of two months was admitted after initial examinations, showing a very huge mass over the right upper lobe. Right pneumonectomy with partial rib resection of 3rd, 4th, and 5th ribs was performed due to the initial diagnostic impression of squamous cell carcinoma by the fine needle aspiration biopsy. The operative field presented a mass locating across the interlobal fissure with severe adhesions to the chest wall. Postoperatively, the patient received 5,000 rads of radiotherapy and presently, 6 months later, has shown no signs of recurrence.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1255-1258
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• 2015

Background: Locally advanced head and neck cancer is generally incurable and has a short survival rate. This study aimed to evaluate symptom relief, disease response, and acute toxicity after palliative hypo-fractionated radiotherapy and long-term survival in affected patients. Materials and Methods: Between January 2011 to December 2011, 80 patients who were histopathologically diagnosed as having stage III or stage IV head and neck squamous cell carcinoma based on Eastern Cooperative Oncology Group (ECOG) performance status 1-3, were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Later these patients were evaluated on 30th day after completion of treatment for disease response based on World Health Organisation (WHO) criteria and palliation of symptoms using symptomatic response grading and acute toxicities by the Radiation Therapy Oncology Group (RTOG). Many patients were given post radiation therapy (RT) palliative chemotherapy for appropriate palliative care and a few patients were selected for further curative RT. The overall survival was also evaluated among this group of patients with last follow up date of 1st May, 2014. Results: The most common presenting complaint was pain followed by dysphagia. Most patients (60-70%) had appreciable relief in their presenting symptoms. A good response was observed in the majority following palliative RT; a few patients had progressive disease and some had stable and regressed disease. None of the patients experienced radiation toxicity that required hospital admission. Almost all showed grade one and two acute skin and mucosal toxicity one month after completion of treatment. The mean survival days for patients given only hypofractionated palliative RT was 307 days, those with post palliative RT and palliative chemotherapy was 390 days and patients who went on to receive further palliative RT and curative RT dose had significantly overall survival of 582 days. Conclusions: Advanced head and neck cancer should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in a great proportion of patients and should be followed by palliative chemotherapy or curative RT in suitable cases for long-term symptom-free survival.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.10
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• pp.4335-4338
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• 2015

Background: Oral cancer is the third most common malignancy in Saudi Arabia, the highest incidence of which is reported from Jazan province. The objective of this study was to evaluate the association of various locally used substances, especially shamma, with oral cancer in the Jazan region of Saudi Arabia. Materials and Methods: A hospital-based case-control study was designed and patient records were scanned for histologically confirmed oral cancer cases. Forty eight patients who were recently diagnosed with oral cancer were selected as cases. Two healthy controls were selected for each observed case and they were matched with age (+/- 5 years) gender and location. Use of different forms of tobacco such as cigarettes, pipe-smoking and shamma (smokeless-tobacco) was assessed. Khat, a commonly used chewing substance in the community was also included. Descriptive analysis was first performed followed by multiple logistic regression (with and without interaction) to derive odds ratios (ORs) and 95% confidence interval (CIs). Results: Mean age of the study sample (56% males and 44% females) was 65.3 years. Multinomial regression analysis revealed that shamma use increased the odds of developing oral cancer by 29 times (OR=29.3; 10.3-83.1). Cigarette (OR=6.74; 2.18-20.8) was also seen to have an effect. With the interaction model the odds ratio increased significantly for shamma users (OR=37.2; 12.3-113.2) and cigarette smokers (OR=10.5; 2.88-3.11). Khat was observed to have negative effect on the disease occurrence when used along with shamma (OR=0.01; 0.00 - 0.65). Conclusions: We conclude that shamma, a moist form of smokeless tobacco is a major threat for oral cancer occurrence in the Jazan region of Saudi Arabia. This study gives a direction to conduct further longitudinal studies in the region with increased sample size representing the population in order to provide more substantial evidence.

• Radiation Oncology Journal
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• v.16 no.2
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• pp.139-145
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• 1998

Purpose : The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supralottic cancer. Materials and Methods : Twenty-one Patients with squamous cell carcinoma of the supralottis were treated with radiotherapy at Gyeongsang National University Hospital between 1590 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. Results : Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-rear actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III and 28.6% in Stage IV(p=0.54), The 5-year local control rate was 52.0% for 21 patients. The 5-rear local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV(p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. Conclusion : In early stage(Stage I and II) supralottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage(Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supralottic cancer.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.253-259
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• 2008

Background: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. Material and Method: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. Result: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. Conclusion: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.176-183
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• 1999

Chronic osteomyelitis have been treated with wound dressing and antibiotics therapy often results in healing but foul odor pus discharges from the fibrotic soft tissues reactivates and requires appropriate control of the infection. Debridement of the wound, curettage and sequestrectomy, bone graft and immediate free flap transplantation is the curative protocol for the chronic osteomyelitis in the lower extremity. Authors have treated 7 cases of chronic osteomyelitis in the lower extremity with microsurgical free tissue transplantation at Department of Orthopedic Surgery, Chonbuk National University Hospital from December 1993 through February 1998. The results are as follows. 1. The chronic osteomyelitis occurred in tibial shaft in 4 cases, in calcaneus 2 cases and in femur 1 case. 2. Duration of the chronic osteomyelitis was at average 31.6 years. 3. Squamous cell carcinoma in the surrounding fibrotic tissue was biopsied in 1 case. 4. 4 cases had no trauma and occurred through hematogenous infection and 3 cases had fracture trauma. 5. Wound debridement and immediate free muscle transplantation had done in 5 cases and wound debridement, sequestrectomy and immediate free muscle transplantation in 2 cases. 6. Rectus abdominis muscle transplantation had peformed in 4 cases(57.1%), latissimus dorsi mucle 1 case(14.3%), latissimus dorsi myocutaneous 1 case(14.3%) and gracilis 1 case (14.3%). 6 cases of 7 were success(85.7%). 7. 1 case of failed latissimus dorsi musculocutaneous flap in thigh had done above knee amputation and 1 case of chronic posttraumatic osteoarthritis of the ankle joint had done below knee amputation at other hospital.