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1.  Asthma in Rhinosinusitis: A Survey from Iran 
The coexistence of asthma and chronic rhinosinusitis (CRS) is more common than expected given their individual prevalence in the general population and may affect patient’s quality of life. The aim of this study was to evaluate the prevalence of asthma in chronic rhinosinusitis in Mashhad, Northeast Iran.
Materials and Methods:
This study was performed in two university hospital from November 2012 for 12 months. In total, 153 patients with chronic rhinosinusitis were enrolled and referred to a particular pulmonologist for asthma evaluation.
The mean age of participants was 40.54±13.11 years, and 41.8% were male. In total, 63.4% of patients had the polypoid form of CRS. The proportion of patients in this study with asthma was 41.8%, compared with a general asthma prevalence in this region of 13.5%.
There is a high prevalence of asthma among patients with CRS, but it often remains undiagnosed. Asthma in CRS patients should be diagnosed and treated in order to improve patient’s quality of life. We recommend an evaluation of the lower airways in all of these patients as well as further studies in this field.
PMCID: PMC4994987  PMID: 27602339
Asthma; Sinusitis; Spirometry
2.  Montelukast in Adenoid Hypertrophy: Its Effect on Size and Symptoms 
Adenotonsillar hypertrophy (AH) is considered the most common cause of upper respiratory tract obstruction among children. It results in a spectrum of symptoms from mouth breathing, nasal obstruction, hyponasal speech, snoring, and obstructive sleep apnea (OSA) to growth failure and cardiovascular morbidity. Adenotonsillectomy is a typical strategy for patients with AH, but may lead to serious complications such as bleeding (4–5%) and postoperative respiratory compromise (27%), especially among young children, as well as recurrence of adenoid tissue (10–20%). Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The inflammatory mechanism proposed for AH has lead to the use of anti-inflammatory drugs to manage this condition. The present study aimed to evaluate the effect of chewable tablets of montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH.
Materials and Methods:
Sixty children between the ages of 4–12 years with >75% choanal obstruction on primary nasal endoscopy were recruited in this randomized, placebo-controlled trial and randomly divided into two groups. The study group was treated with montelukast 5 mg daily for 12 weeks while the control group received matching placebo for the same period of time. A questionnaire was completed by each child’s parent/guardian to assess the severity of sleep discomfort, snoring, and mouth breathing before and after the intervention.
Adenoid size decreased in 76% of the study group compared with 3% of the placebo group after 12 weeks. A statically significant improvement was observed in the study group compared with the placebo group in terms of sleep discomfort, snoring, and mouth breathing. The symptoms average total score dropped from 7.7 to 3.3 in the study group, while in the placebo group the total score changed from 7.4 to 6.7.
Montelukast chewable tablets achieved a significant reduction in adenoid size and improved the related clinical symptoms of AH and can therefore be considered an effective alternative to surgical treatment in children with adenoid hypertrophy.
PMCID: PMC4706629  PMID: 26788489
Adenoid hypertrophy (AH); Montelukast; Mouth breathing; Sleep discomfort; Snoring
3.  Early Post Operative Enteral Versus Parenteral Feeding after Esophageal Cancer Surgery  
The incidence of malnutrition in hospitalized patients is reported to be high. In particular, patients with esophageal cancer are prone to malnutrition, due to preoperative digestive system dysfunctions and short-term non-oral feeding postoperatively. Selection of an appropriate method for feeding in the postoperative period is important in these patients.
Materials and Methods:
In this randomized clinical trial, 40 patients with esophageal cancer who had undergone esophagectomy between September 2008 and October 2009 were randomly assigned into either enteral feeding or parenteral feeding groups, with the same calorie intake in each group. The level of serum total protein, albumin, prealbumin, transferrin, C3, C4 and hs-C-reactive protein (hs-CRP), as well as the rate of surgical complications, restoration of bowel movements and cost was assessed in each group.
Our results showed that there was no significant difference between the groups in terms of serum albumin, prealbumin or transferrin. However, C3 and C4 levels were significantly higher in the enteral feeding group compared with the parenteral group, while hs-CRP level was significantly lower in the enteral feeding group. Bowel movements were restored sooner and costs of treatment were lower in the enteral group. Postoperative complications did not differ significantly between the groups. There was one death in the parenteral group 10 days after surgery due to myocardial infarction.
The results of our study showed that enteral feeding can be used effectively in the first days after surgery, with few early complications and similar nutritional outcomes compared with the parenteral method. Enteral feeding was associated with reduced inflammation and was associated with an improvement in immunological responses, quicker return of bowel movements, and reduced costs in comparison with parenteral feeding.
PMCID: PMC4639684  PMID: 26568935
Esophageal cancer; Enteral feeding; Parenteral feeding; Nutritional assessment
4.  The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery 
Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR).
Materials and Methods:
This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A) and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B). Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery.
The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC) and 28 patients had adenocarcinoma (ACC). There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT), or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected.
The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer.
PMCID: PMC4710880  PMID: 26788476
Esophageal Cancer; Neoadjuvant Therapy; Surgery
5.  The Efficacy of Magnetic Resonance Imaging and Color Doppler Ultrasonography in Diagnosis of Salivary Gland Tumors 
Background and aims. Although salivary gland tumors are not very common, early diagnosis and treatment is crucial because of their proximity to vital organs, and therefore, determining the efficacy of new imaging procedures becomes important. This study aimed to evaluate the efficacy of magnetic resonance imaging (MRI) and color doppler ultrasonography parameters in the diagnosis and differentiation of benign and malignant salivary gland tumors.
Materials and methods. In this cross-sectional study, color doppler ultrasonography and MRI were performed for 22 patients with salivary gland tumor. Demographic data as well as MRI, color doppler ultrasonography, and surgical parameters including tumor site, signal in MRI images, ultrasound echo, tumor border, lymphadenopathy, invasion, perfusion, vascular resistance index (RI), vascular pulse index (PI) were analyzed using Chi-square test, Fisher's exact test, and independent t-test.
Results. The mean age of patients was 46.59±13.97 years (8 males and 14females). Patients with malignant tumors were older (P < 0.01). The most common tumors were pleomorphic adenoma (36.4%), metastasis (36.4%), and mucoepidermoid carcinoma (9%). Nine tumors (40.9%) were benign and 13 (59.1%) were malignant. The overall accuracy of MRI and color doppler ultrasonography in determining tumor site was 100% and 95%, respectively. No significant difference observed between RI and PI and the diagnosis of tumor.
Conclusion. Both MRI and ultrasonography have high accuracy in the localization of tumors. Well-identified border was a sign of benign tumors. Also, invasion to adjacent structures was a predictive factor for malignancy.
PMCID: PMC4288916  PMID: 25587388
Color; doppler; magnetic resonance imaging; salivary gland neoplasms; ultrasonography
6.  Platelet-Rich Fibrin: An Autologous Fibrin Matrix in Surgical Procedures: A Case Report and Review of Literature 
The healing process after surgery is a challenging issue for surgeons. Various materials and techniques have been developed to facilitate this process and reduce its period. Fibrin adhesives are often used in cardiothoracic and vascular surgery to seal diffuse microvascular bleeding and in general and plastic surgery to seal wound borders. This Case report and literature review will introduce the various usages of platelet-rich fibrin in different surgical procedures and the method of producing the matrix.
Case Report:
A 24-year old man with periorbital skin avulsion treated with PRF membrane has been reported and discussed in this paper.
Platelet-rich fibrin is a natural autologous fibrin matrix, which can be produced with a simple blood sample and a table centrifuge. The material has been used in a wide range of surgical procedures to shorten the healing period and reduce post-surgical complications.
PMCID: PMC3846193  PMID: 24303410
Blood sample; Fibrin matrix; Healing; Platelet-rich fibrin; Surgery

Results 1-6 (6)