Reviews in Clinical Medicine
Volume:2 Issue: 2, Spring 2015

Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer (NSCLC) and esophageal carcinoma (EC) are among the solid tumors in which sentinel node (SN) mapping has been applied. In the current systematic review, we gathered the best available evidence (systematic reviews) in this regard and presented the results in a systematic review format. We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: (lung OR esophagus OR esophageal) AND sentinel AND (“systematic review” OR meta-analysis OR metaanalysis). No language limit was imposed on the search strategy. Systematic reviews and meta-analyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study. Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors. SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique (using radiotracers, peri-tumoral injection) and restriction of the patients to less advanced cases (cN0 and T1, 2) would ensure the best results with high detection rate and sensitivity.

Noise pollution in hospital wards can arise from a wide range of sources including medical devices, air-conditioning systems and conversations among the staffs. Noise in intensive care units (ICUs) can disrupt patients’ sleep pattern and may have a negative impact on cognitive performance. In this review article, we searched through PubMed and Google Scholar, using [noise and (ICU or “intensive care unit”)] as keyword to find studies related to noise pollution in ICUs. In total, 250 studies were found among which 35 articles were included. The majority of the reviewed studies showed that noise pollution levels were higher in ICUs than the level recommend by The United States Environmental Protection Agency and World Health Organization. Noise pollution was mostly caused by human activity and operating equipments in ICUs and other hospital wards. As the results indicated, identifying, monitoring and controlling noise sources, as well as educating the hospital staffs about the negative effects of noise on patients’ health, can be highly effective in reducing noise pollution.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neuropsychiatric illness, which affects about 5% of children worldwide. An 80% genetic background is responsible for ADHD due to its appearance in familial relationships. In addition, dopamine regulation in synaptic spaces, which have a central role in development of ADHD, is moderated by dopamine transporter neurotransmitter, which in turn is modulated by dopamine transporter gene named SLC6A3 or DAT1. Methylphenidate as the first line and most important prescribed medication for ADHD blocks dopamine transporter and increases the dopamine concentration in synaptic clefts. In theory, methylphenidate relay to dopamine transporter to play a role, and dopamine transporter synthesis is dependent on DAT1. This gene have 40 base pair in its 3`-untranslated region end that repeat from 3 to 11 times, with most frequent 9 and 10 repeats in human, forming several alleles in carriers including 9R and 10R and genotypes including 9R/9R, 10R/10R, 9R/10R. These genotypes, as the first suspected candidates, may explain why methylphenidate therapy is not sufficient some patients and how the side effects appear in some cases and not in all patients. Many studies have performed to investigate the association between responses to methylphenidate and genotypes and yet no consistency has occurred. This article has a rapid review on concerned literature.

Borderline ovarian tumor or low malignant ovarian tumor presents in 10-15% of all ovarian cancers, which usually affects younger women and have favorable prognosis even with conservative surgery, in which fertility can be preserved. Lack of reliable diagnostic tool to indicate the type of malignancy before or at the time of surgery makes the borderline ovarian tumor one of the most controversial topics in gynecology. This might lead to many overtreatment cases with radical surgery or undertreatment with conservative surgery with the higher rate of overtreatment compared to under treatment.In this review article, we extensively searched for all reported data regarding the accuracy of frozen section in borderline ovarian tumor. Reviewing the results of six studies, which specifically considered the accuracy of frozen section in borderline ovarian tumors, revealed an accuracy of 60% with an agreement between final pathology and frozen section results. Overall, 24.5% of under-diagnosed malignant cases interpreted to be benign and 4.9% overdiagnosed cases with benign tumor considered as a malignant. Frozen section is a reliable tool to exclude benign tumor from borderline and malignant but underdiagnosed percentage is higher. There are limitations in this review including the small number of enrolled cases, different time of diagnosis and different investigated countries and the discrepancies between the studied articles in this review.

Cancerous patients, under the chemotherapy or radiotherapy, are at high risk of malnutrition due to the associated complications with the treatment procedures such as chewing problems, dysphagia, nausea etc. Considering the patients’ history of alcohol consumption, smoking or any other diseases and performing several physical examinations are essential in early identification of high-risk patients for nutritional complications, losing unintentional weight and fat free mass. In this review, we tried to briefly explain the risk of malnutrition in patients with head and neck cancers who are undergoing surgery, chemotherapy and radiotherapy. Oral nutrition, nasogastric tube and percutaneous endoscopic gastrostomy are different methods of nutritional interventions, which have been compared due to their efficacy in maintaining the patients’ weight. In this study, we reviewed the results obtained in clinical trials about the efficacy of intense nutritional intervention on limiting the chemoradiotherapy-associated complications in patients with head and neck cancers.

Attention-deficit/hyperactivity disorder is one of the most common psychiatric disorders in childhood. The medications which inhibit the reuptake of noradrenline and dopamine including psychostimulants such as methylphenidate and dextroamphetamine and non-stimulating pre-frontal cortex noradrenaline reuptake inhibitor such as atomoxetine, are the standard treatment of ADHD. Adverse effects of stimulants have been reported in thirty percent of patients with attention-deficit/hyperactivity disorder. More than fifty percent of the parents of these children have tried one or more complementary or alternative medicines including vitamins in their children. Ginkgo biloba has been described to be effective for various neuropsychiatric symptoms. It was assumed that ginkgo biloba might improve some symptoms of attention deficit disorder as well. Nevertheless, no systematic study reported a possible efficacy of ginkgo biloba in attention deficit disorder. This review article evaluates the available evidence on the efficacy of ginkgo biloba medication in Attention-deficit/hyperactivity disorder children to present an appropriate guidance for this common child disorder.

Environmental pollution is one of the most serious and fast-growing problems in the world of today. Lead poisoning is a threatening environmental situation with the potential of causing irreversible health issues and serious negative consequences in adults and children. Lead proves to have almost no clear biological function. However, once it enters the body, it is known to cause severe health effects, which might be irreversible. In this article, we aimed to review the related literature to find evidence concerning the effect of lead toxicity on CNS, particularly its role in febrile convulsion. In this review, PubMed database was searched using MeSH terms. One hundred and fifty seven articles were retrieved, most of which were irrelevant to the topic. After a thorough search in PubMed and Google Scholar, seizure was shown to be one of the consequences of lead toxicity, but there was no evidence of epilepsy or febrile convulsion, induced by this metal contamination.

Subarachnoid hemorrhage is one of the most important and dangerous neurologic emergencies worldwide. It is characterized by a sudden and severe headache caused most commonly by the rupture of intracranial aneurysm. Cerebral vasospasm is the most important cause of disability and death in whom survived from the first event. Early diagnosis and management of cerebral vasospasm could prevent and reduce its morbidity and mortality. Thus, an ideal technique must be able to detect the vasospasm before the occurrence of neurological deficits. Perfusion computed tomography could assess vascularity of brain including cerebral blood flow, cerebral blood volume, time to peak and mean transit time. For this application, perfusion computed tomography and computed tomography angiography techniques offer significant advantages and can result in early diagnosis of vasospasm. In this review, we discuss the utility of these two techniques and their safety in the diagnosis and the management of vasospasm following subarachnoid hemorrhage.

Chronic myelogenous leukemia is a myeloproliferative disorder presenting with anemia, elevated blood granulocytosis and the presence of immature granulocytes, basophilia, frequently thrombocytosis and spleen enlargement. The diagnosis is stabilized by hematopoietic stem cell expressing a fusion gene (BCR/ABL) resulted from translocation of 9 and 22 chromosomes. The products of this gene play a central role in developing chronic myelogenous leukemia including maintenance of chronicity and/or progress to accelerated phase and or blastic crisis. Imatinib is the first generated tyrosine kinase Inhibitor, which prevents ATP binding to a specific situation of tyrosine kinase molecules that are involved in phosphorylation of membranous proteins and activation of the pathways that are necessary for tumor cell survey and proliferation. Therefore, tyrosine kinase inhibitor inhibits signaling proteins, which are responsible for tumor growth, invasion, angiogenesis and even metastasis. Although tyrosine kinase inhibitor are specific targeted-designed compounds, every agent interacts with many kinds of tyrosine kinases and produces many unwanted effects. One of the undesirable adverse effects is thyroid dysfunction. The first reported article about tyrosine kinase inhibitor-induced thyroid dysfunction published in 2005 and since then few studies have demonstrated thyroid disturbances ranging from subclinical thyroid dysfunctions to overt clinically thyroid disorders during tyrosine kinase inhibitor therapy. This review attends to summarize only imatinib-induced thyroid disturbances in CML patients with positive Philadelphia chromosome in recent years.

Cerebrovascular event is one of the important causes of death in the world. Carotid artery stenosis is one of main risk factors of cerebrovascular events. Risk factors for atherosclerosis are found in carotid artery stenosis. Thus, coincidence of coronary artery disease and carotid artery stenosis were observed. In an individual with high risk of coronary artery plaque formation, peripheral artery stenosis is imaginable. Histological morphology and plaque formation in coronary artery disease and carotid artery stenosis are similar and they occur together most of the time. Although many similar findings were shown in coronary artery disease and carotid artery stenosis, carotid artery stenosis is associated with more severe stenosis compare with coronary artery disease. Carotid artery stenosis does not have exact similar biological activity with coronary artery disease.Some invasive and non-invasive diagnostic methods are established for carotid artery stenosis detection.Same medical and surgical treatment techniques could be used for carotid artery stenosis management that vary due to patient-to-patient specific conditions.

The need for both pre- and post-reduction radiographs has recently been questioned when treating shoulder dislocation. Several case reports and case series have suggested that ultrasonography might be useful bedside diagnostic modality for evaluating shoulder dislocation.The purpose of this review was to evaluate studies that questioned necessity of radiographs for shoulder dislocation and also studies that evaluated bedside ultrasound as an alternative modality in shoulder dislocation. Ultrasonography can be used in patients with suspected shoulder dislocation. It cannot replace radiography because of possible associated fractures but it can be used before and after reduction to confirm successful relocation to reduce the risk of repeated sedation. It can also increase the certainty of physicians in cases that shoulder dislocation management needs to be performed without X-ray assessment.

Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting.In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine.It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphine.