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Background. As the second leading cause of death in women in the world, breast cancer has several physical and psychological effects. Nowadays, nonclinical approaches such as patient empowerment have been considered by physicians along with clinical care. Given the increasing number of breast cancer women worldwide, promoting the empowerment of these patients is one of the key factors affecting their survival and quality of life. Therefore, because of no comprehensive research on the empowerment needs and related improvement strategies, this study is aimed at determining the empowerment status of breast cancer patients referred to the Shahid Motahari Breast Cancer Clinic in Iran, Shiraz, and at providing strategies to improve their empowerment in 2021. Methods. This applied study was conducted in two phases. In the quantitative phase, 310 Cancer-Related Patient Empowerment Scale questionnaires (Persian format) were distributed among the studied patients selected through the random sampling method in the clinic, and the items with "unacceptable status" became the basis for determining the empowerment strategies through the scoping review and semistructured interviews with 22 medical staff and patients through the thematic analysis. The collected data were analyzed using the SPSS 20.0 and MAXQDA10 software. Results. The mean score of the participants' empowerment strategies was 3.58. The results showed that trust in the physician, family support, and spiritual beliefs could affect the empowerment of the studied patients. Moreover, the participants needed empowerment strategies in 11 scale items with unacceptable status, for which 46 strategies were determined in the scoping review and interview phase. Conclusion. The results of this study provided useful strategies for empowering breast cancer patients, the most important of which were classified into five categories of financial support, informational support, interaction with the physician, occupational support, and complementary therapies, the use of which by the stakeholders could help to improve the patients' quality of life while improving their empowerment. [ABSTRACT FROM AUTHOR]

Analysis of volatile organic compounds (VOCs) emitted from the human organism can provide useful information about normal physiological processes as well as pathological disorders. The aim of this work is to develop a portable, inexpensive, on-site, fast, small design paper-based device based on the electronic nose (E-nose) concept for the detection of malignancy in gastric cancer (GC) by analyzing volatile organic compounds emitted from human tissue. For this purpose, cancerous and noncancerous tissue samples were provided from 22 patients diagnosed with GC, esophageal cancer (EC), and neuroendocrine carcinoma (NEC). In this system, eight types of fluorescent metallic nanoclusters (NCs) as sensing elements were immobilized on a paper substrate. A microcentrifuge tube was used to create a reaction environment to communicate between a paper device containing NCs and VOCs emitted from tissue samples. After exposing the sensors to headspace of the tissues, the emitted VOCs reacted with NCs and led to changes in the fluorescence intensity of NCs. For pattern recognition and statistical analysis, chemometric methods including principal component analysis, linear discriminant analysis, and partial least square discriminant analysis were applied. The sensor array was able to discriminate between fresh cancerous and normal tissues with 95% accuracy. In summary, we fabricated an optical nose device that can sniff the odor of tissues and then identify the malignant tissues in less than 4 h. So, it has the potential for point-of-need applications in the hospital and can offer results in the same time duration required for a patient to recover from anesthesia. [ABSTRACT FROM AUTHOR]

Background: In the present paper, the main diagnostic tool for re-evaluation of axillary lymph node involvement and planning of surgery after neoadjuvant chemotherapy (NAC) is ultrasound whose accuracy we aimed to determine herein. The high precision of ultrasound in diagnosis of metastatic axillary lymph nodes in untreated patients is well known; however, its worth in patients who received NAC is highly controversial. Method: We enrolled 165 breast cancer patients receiving NAC in this retrospective cohort study. They all had undergone post-NAC ultrasound done before surgery. The ultrasound reports were reassessed and validated by a breast radiologist. Finally, the histopathology reports were compared to those of the ultrasound. Results: Among 165 surveyed post-NAC ultrasounds, 53 women had positive results and 112 had negative results. Pathology and ultrasound reports were accordant in 93 women and adverse in 112 others. The false negative rate of post-NAC axillary ultrasound was calculated as 60.6%. The sensitivity and specificity of post-NAC AxUS were 39.4% and 79%, respectively. After NAC, there were certain changes in ultrasound reports from positive to negative in 50% and pathologic complete clearance was observed in just 28% of the women who were initially clinically lymph node positive. Conclusion: Ultrasound was not found to be an accurate and appropriate tool for evaluation of axillary lymph node involvement in breast cancer patients who receive NAC. By changing the primarily established surgical plan from ALND to SLNB, based on the ultrasound findings, patients may remain undertreated. Furthermore, the axillary nodes pathologic clearance after NAC was observed in less than one third of the women who were initially clinically node positive; accordingly, surgeons should be cautious about the optimum response of axillary metastatic lymph nodes to NAC. [ABSTRACT FROM AUTHOR]

Background: Much is still unknown regarding the clinicopathology and prognosis of patients with multifocal/multicentric breast cancer (MMBC). We herein compared the clinicopathology and prognosis of patients with unifocal and MMBCs. Method: This cross-sectional research is a part of Shiraz Breast Cancer Registry (SBCR). We studied all the patients in the SBCR (n=6145). Ultrasound reports were used to differentiate between MMBCs and unifocal breast cancers (BCs). All the patients were examined with mammography and the diagnosis was confirmed postoperatively via pathology reports. Results: After exclusion, 4045 patients entered the study (n=1072 and n=2973 for multifocal/multicentric and unifocal BCs, respectively). The mean follow-up period was 57.9 (0.27-275) months. Patients with MMBCs had higher rates of mastectomy (48% vs. 40.1%; P < 0.001) and higher rates of HER-2 overexpression (32.1% vs. 26%; P = 0.001) compared with those with unifocal BCs. Tumor size, lymph node involvement, type of axillary management, chemotherapy, radiotherapy, hormonal therapy, recurrence rates, histological grade, lymphovascular invasion, axillary node involvement, estrogen and progesterone receptor expression status, tumor, node, and metastasis staging were not significantly different between the groups. Five-year overall survival was 88.3% and 89% (P = 0.8) for unifocal and MMBCs, respectively; moreover, five-year disease-free survival was 80.2% and 81.2% (P = 0.41), respectively. Conclusion: Despite the controversy regarding prognosis and surgical management in MMBCs, we found that MMBCs had similar clinicopathological features and prognosis compared to unifocal BCs. Survival, recurrence, and metastasis were similar among the two groups. [ABSTRACT FROM AUTHOR]

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly used to treat peritoneal carcinomatosis (PC). The objective was to evaluate the outcomes of cytoreductive surgery (CRS) and HIPEC in our center. Method: In this retrospective study, data were collected from 43 patients with PC who underwent CRS-HIPEC in 2016 at Faghihi Hospital of Shiraz University of Medical Sciences. Outcomes were collected and analyzed. Analyses were conducted through SPSS 23. P-value < 0.05 was considered to be statistically significant. Results: The mean age of the patients was 52.23 ± 11.82 years. The participants in the study analysis consisted of 36 female (83.7%) and seven male patients (16.3%). The most common primary tumor was ovarian cancer (62.8%). Completeness of the cytoreduction score of CC0/CC1 was obtained in 87.7% of the patients. The 1- and 3-year overall survivals were 88% and 60%, respectively. Conclusion: Our study supports that employing CRS and HIPEC for PC is feasible with acceptable morbidity in our center. [ABSTRACT FROM AUTHOR]

Background: Mucinous breast carcinoma (MBC) is a subtype of breast cancer categorized by the presence of extracellular mucin and has more favorable prognosis than invasive carcinoma of no special type of breast cancer. The present study incorporates 27 years of practical experience from a breast disease research centerbased series of cases regarding MBC and invasive ductal carcinoma (IDC). Method: In this retrospective study, we studied the medical documents of 7,739 patients in the Breast Disease Research Center, Shiraz University of Medical Sciences, from December 1993 to January 2019. TNM data, demographic status, pathologic stage, histological grade, hormonal receptor data, recurrence, overall survival (OS), and disease-free survival (DFS) were reviewed. We also statistically evaluated the clinical and histopathological differences of pure, mixed MBC, and IDC using SPSS, version 21.0 (IBM, USA). P<0.05 was considered as statistically significant. Results: A total of 78 and 31 patients were observed to have pure and mixed MBC, respectively, and 5,774 breast cancer patients had IDC. The pure MBC group showed a lower histological grade and pathologic stage and a larger tumor size compared with mixed MBC (P<0.001). The pure MBC patients had significantly less perinural and lymphovascular invasion and had less HER-2 positive status in comparison with IDC patients (P=0.023). The DFS and OS did not differ the between groups. Conclusion: MBC is a rare diagnosis with a favorable prognosis due to low lymph node metastases. [ABSTRACT FROM AUTHOR]

We report a case of colon cancer with pancreatic and interesting heart metastasis several months prior to disseminated metastases. The case was a 59-year-old man with a cecal cancer (T4N2); he received chemotherapy with XELOX regimen and then radiotherapy up to a dose of 45 Gy. He was under close and regular follow-up. After 42 months, he developed jaundice and computed tomography (CT) scan showed an isolated mass in the pancreas. We performed Whipple's operation and the pathology report was pancreatic metastasis. He received chemotherapy and was relatively well until his CEA rose again and the chest CT scan indicated cardiac metastasis. We resected the metastasis and administered chemotherapy. Unfortunately, the case developed brain metastasis and passed away. We searched the literature and found 15 cases of colon cancer and cardiac metastasis. We found no cases with metastasis from colon cancer to the left side. Although cardiac metastasis has a poor prognosis, it might be more prevalent than what is generally believed. [ABSTRACT FROM AUTHOR]

Background: Medullary breast carcinoma (MBC) is a unique histological subtype of breast cancer. The present study aimed to evaluate the classic and non-classic characteristics of MBC and its differences with IDC. The present review study incorporates 22 years of practical experience from a breast disease research center-based series of cases. Methods: Retrospectively, the medical records of 3,246 patients were reviewed in the Breast Disease Research Center, Shiraz University of Medical Science (Shiraz, Iran), from December 1993 to December 2015. The tumor size, lymph node metastasis, pathologic stage, nuclear and histological grade, hormonal receptor status, recurrence, disease-free, and overall survival were reviewed. Differences between medullary breast carcinoma and invasive ductal carcinoma were analyzed statistically using the Chi-square, Fischer, independent-sample t test, and Kaplan- Meier analysis (SPSS version 19.0). P<0.05 were considered statistically significant. Results: A total of 179 patients were identified with MBC and 3,067 patients were identified with IDC. The MBC group had a significant association with a higher histological grade (P<0.001) as well as negative estrogen receptor (P<0.001), progesterone receptor (P<0.001), and HER-2 (P=0.004) status. The MBC patients predominantly had triple-negative breast cancer (TNBC) according to the molecular subtype (P<0.001). In local invasion, MBC was less invasive compared to IDC (P<0.001). The disease-free survival (DFS) and overall survival (OS) differed significantly between the MBC and IDC groups (5-year DFS: 94.2% vs. 86.3%, P=0.008; 5-year OS: 98.1% vs. 92.8%, P=0.004). Conclusion: Despite the poor and aggressive pathological features of MBC, its clinical outcome is more favorable compared to IDC. Our findings can be useful in improvement of diagnosis and treatment of less known breast cancer subtypes, such as MBC. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy, as an adjuvant treatment, plays a well-known role in prevention of locoregional recurrence in breast cancer patients. This study aims to investigate the impact of radiotherapy in patients with N1 disease. Methods: In this retrospective study, we reviewed the characteristics and treatment outcomes of 316 patients with a biopsy proven diagnosis of breast carcinoma and 1-3 positive axillary lymph nodes. The patients received treatment between 1995 and 2014. The patients had a median follow-up of 60 (range: 6-182) months. Results: This study was conducted on 316 patients with a median age of 48 (range: 26-86) years. Among patients, 215 underwent modified radical mastectomy and 101 had breast-conserving surgery before adjuvant treatment. Indeed, 259 patients received radiotherapy (radiation group) and 57 did not (control group). There was locoregional recurrence in one control group patient and two patients in the radiation group. Multivariate analysis results indicated hormone receptor status as an independent prognostic factor for the 5-year disease-free survival rate. Estrogen and progesterone receptor negativity (HR = 1.80, 95% CI: 1.02-3.19, P=0.043) also had a negative influence on the 5-year disease-free survival rate. However, radiotherapy had no significant effect on disease-free survival (P=0.446) and overall survival (P=0.058) rates. Conclusion: The results showed that adjuvant radiotherapy had no prognostic impacts on locoregional and distant disease control in breast cancer patients with N1 disease. [ABSTRACT FROM AUTHOR]

Bilateral synchronous male breast cancer is very rare. A 63-year-old male presented with rapidly progressive enlarging bilateral breast masses without ulceration and bloody nipple discharge. Synchronous bilateral breast cancer was diagnosed by fine needle aspiration cytology. Pathology study revealed grade 2 invasive ductal carcinoma in both breasts. He underwent a bilateral modified radical mastectomy followed by chemotherapy and hormone therapy. The importance of this case report is to create increased attention to the fact that, although rare, breast cancer can occur in males. Early presentation and compliance with treatment modality provide a better outcome. [ABSTRACT FROM AUTHOR]

A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the most prevalent malignancies in women worldwide, and the rate of breast cancer is increasing among Iranian women. The purpose of this study is to determine the cost-effectiveness of intraoperative frozen section analysis in women with breast cancer. Methods: This study was a cost-effectiveness analysis, which was implemented as a cross-sectional study from a societal perspective. In this case, total direct and indirect costs were calculated, and the study outcome was involved in preventing reoperation. A data collection form has been used to collect the cost and effectiveness data. The sample size was comprised of all the patients referred to the hospitals of Shiraz University of Medical Sciences for breast cancer surgery in 2019. The patients were studied in two different groups, including individuals who received frozen counseling during surgery, and individuals who did not receive it. A one-way sensitivity analysis was performed for this case. Moreover, the Tree Age and Microsoft Excel Software were employed for analyzing processes. Results: The results demonstrated that the mean costs of frozen and non-frozen patients were 4168$ and 3843$ purchasing power parity (PPP), respectively. In addition, the effectivenesses were 0.996 for the former and 0.8 for the latter. Furthermore, the incremental cost-effectiveness ratio (ICER) was 1658.2 PPP$. This issue revealed that the frozen section procedure during surgery was more cost-effective than the other case. Because, the cost-effectiveness of this option was below the threshold. Besides, the one-way sensitivity analysis confirmed the robustness of the study results. Conclusion: The results showed that performing frozen sections during surgery in women with breast cancer was more cost-effective than ignoring them. Indeed, the frozen section can prevent the costs of subsequent reoperations. [ABSTRACT FROM AUTHOR]

Background: Determining the risk of severe course coronavirus disease 2019 (COVID-19) and its related factors in survivors of common cancers such as breast cancer is important. This study has been designed to evaluate the prevalence of COVID-19 infection in breast cancer survivors and also estimate the risk of severe disease in this population., Methods: Out of 6134 patients in the Shiraz Breast Cancer Registry (SBCR), A total of 292 patients who elapsed less than a year from their breast cancer diagnosis were excluded. We called 5842 patients. Finally, 4135 breast cancer survivors who agreed to cooperate were screened for COVID-19 symptoms by a symptom-based questionnaire in November 2020. COVID-19 in symptomatic participants was confirmed by a polymerase chain reaction (PCR) test. The clinical and paraclinical data of the COVID-19 course were collected for patients with a positive PCR test., Results: A total of 247 (5.9%) participants had at least reported one of the COVID-19 symptoms. Also, 17% of symptomatic participants had a positive PCR test; 83.7% had mild disease, 9.5% moderate, and 16.7% had severe conditions. Chronic cardiovascular disease, hypertension, and diabetes were related to an increased risk of severe illness ( P = 0.018, P = 0.018, P = 0.002)., Conclusion: This study suggests that breast cancer intermediate and longtime survivors without other underlying diseases are considered at low risk for developing severe/critical COVID-19., Competing Interests: The authors declare that they have no competing interests., (© 2023 Iran University of Medical Sciences.)

Background: Breast cancer is the most common cancer in women and surgery is necessary for its treatment. We aimed to determine the oncologic outcomes, satisfaction with breasts, and psychosocial well-being in the patients with breast cancer, after oncoplastic and conventional breast conserving surgery (BCS)., Method: The patients with breast cancer from Shahid Motahari Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from December 2020 to December 2021 were allocated to two groups, one who had undergone BCS alone and the patients who had undergone oncoplastic BCS. For all the patients, demographic data, data about surgery, oncologic outcomes, wound complications, and BREAST-Q© questionnaire score were collected and compared between two groups., Result: The mean age of the patients in the oncoplastic BCS and BCS group was 48.13±9.73 (median=48), and 50.01±8.47 (median=50) years, respectively. The mean score of psychosocial well-being was higher in the oncoplastic BCS group in comparison with BCS alone. ( P -value< 0.0001). Also, the mean score of satisfaction with breast was higher among the oncoplastic BCS group in comparison with the BCS group ( P -value< 0.0001)., Conclusion: Replacing traditional BCS with oncoplastic BCS does not adversely affect the oncologic results of surgery but improves the consequent psychosocial well-being and satisfaction in the patients., Competing Interests: The authors declare no conflict of interest.

A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.

Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause.

Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran., Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients' demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics., Results: Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5%) were men and 158 (38.5%) were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045) and abdominal distention (32.3% vs. 67.7%; p=0.007). Intraoperative findings included adhesion band formation in 50 (48.1%), mass 18 (17.3%), and hernia 7 (6.7%). We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042). The mean hospital stay was significantly higher in those who underwent operation (8.1±7.5 vs. 2.6±2.2 days; p=0.035)., Conclusion: The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better accuracy.