Iranian Journal of Surgery
Year:2017 | Volume:25 | Issue:1|Papers Count:23

Facial nerve palsy affects individuals of all ages, races, and sexes. Psychological and functional implications of the paralysis present a devastating management problem to those afflicted. Facial paralysis following trauma, surgery or due to idiopathic (unknown), eye health at risk.The most devastating sequelae of facial nerve paralysis is the loss of eyelid function. The inability to blink and protect the globe can lead to exposure keratitis, corneal abrasion and even the loss of vision. For this reason, treatment of eye complications for facial paralysis is of major importance.Various methods such as medical treatments (botulinum toxin) or surgical (internal or external weights on the upper eyelid or tarsorraphy) are used. So careful planning and long-term it is necessary to revive the eyelids and face. In this study reviews the various eye problems and the way we treat it.

Introduction & Objective: The lower limb amputations are common musculoskeletal complications of diabetes mellitus and determination of the contributing factors is important for preventive programs.Materials & Methods: In this observational descriptive-comparative cross-sectional study, 100 consecutive patients with diabetic foot attending to Shohada-e-Tajrish Hospital in 2014 and 2015 were enrolled and the association between HbA1C level and lower extremity amputation in them was determined.Results: The results in this study demonstrated that mean hemoglobin A1C levels were 8.5 ± 1.3 and 7.9 ± 1.1 g/dl in those with and without amputation, respectively showing statistically significant difference (P=0.016). The hemoglobin A1C level was not related to location of limb amputation (P>0.05).Conclusions: Totally, it may be concluded that there is significant association between HbA1C level and lower extremity amputation in patients with diabetic foot.

Introduction & Objective: One of the most common findings in human beings and bilaterians is asymmetry including the asymmetry in internal organs and the exterior features. Observing the patients undergoing cosmetic surgeries specially Rhinoplasty which is so common in our outskirt and their pre-op images lead us to suspect that there may be a relation between the face and the torso asymetry and there might be a dominant wider side in both. This persuaded us to plan this study to closely record and analyse the asymetrical findings to achieve a clear conclusion.Materials & Methods: This study was designed in 3 parts: In the 1st part 50 primary rhinoplasty operation notes were reviewed to determine the wider side of upper, middle and lower third of the nose. In the 2nd part 31 patients were the subjects for the measurement of width of the face and torso to reveal any correlation between face and body asymmetry. Image transposition of right and left sides of the face and body photographs of this group was also done to analyze the left and right differences and finally in the 3rd part thoraco-abdominal CT Scans of forty-eight patients were precisely studied to determine the width of the hemi-thorax and hemi-pelvis of each Patient CT Scan.Results: 1. In the rhinoplasty group the width of alar base was wider on the left side (P. value=0.001). Nasal bone width was equal on both sides in 11 cases (22%), while it was wider on left side in 39 cases (78%) (P. value=0.03). To augment lower lateral cartilage (LLC), we put alar strut graft on the right side in 11 cases and 5 on the left side (P. value=0.001). Wider scroll area was found and trimmed in 21 cases on left side and none on the right side (Fig.1-5, Tab.1).2. In the face and torso group although 64.5% had wider left side face and torso, the result was not significant statistically, (P. value=0.2, >0.05) (Fig.6, Tab.2). The photograph transposition result in the above group also showed 68% wider face and body on the same side and predominantly wider on the left side, (Fig.7, Tab.3).3. In the CT scan group, in 40 cases (85.35%) showed same side, thorax and pelvis asymmetry but wider on left side in 33 cases (68.75%) (P. value=0.0015) (Fig.8 & 9, tab.4).Conclusions: Although asymetry of face and torso has already been discussed by many studies, this study could reveal the relation between different part asymertries and more interestingly the predominance of left side in width in both face and torso. This Achievement can help the patient have a more realistic view about the capabilities of his or her surgeon to produce symmetry in order to not being surprised by the outcome of the operation.

Introduction & Objective: Gallstones and its complications are the most gastrointestinal diseases that in most cases, it resulted in hospitalization and cholecystectomy. The aim of present study was to assess body mass index in patients with Gallstones and its complications that underwent cholecystectomy.Materials & Methods: 351 patients who were undergone cholecystectomy due to Gallstones and its complications were included in the present cross-sectional study.201 patients (57.3%) who referred for biliary causes to surgery clinic were included in the control group and 150 patients (42.7%) were allocated to the case group.Results: Chronic cholecystitis with 110 cases (73.3%) accounted for the majority. About the variable body mass index, 9 patients of the case group (6%) and 15 patients of the control group (7.5%) had a body mass index greater than 30 kg per square meter (morbid obesity), but the association was not statistically significant (P=0.784). After examining LDL and HDL, there was no significant difference in LDL/HDL ratio with type of disease of case group.Conclusions: The results of present study showed that the prevalence of gallstones in patients with normal BMI was more than individuals with overweight and fat. In this geographical area, the prevalence of gallstones are depending on other factors such as pregnancies, the underlying chronic disease and blood diseases.

Introduction & Objective: Antimicrobial resistance is a major problem that imposes high costs on burn patients. Therefore, selection of newer methods in order to deal with complications and side effects such as infection or delay in wound healing is needed. The aim of this study was to compare Silver serum levels and acute toxic effects of Nano-silver on histopathology of organs (lungs, liver, kidney, brain) in two types of AgiCoat and Acticoat dressings on second-degree deep burn in rat.Materials & Methods: This is an experimental study conducted at animal laboratory of Hazrat Fatima Hospital in 1394. We divided 24 Sprague-Dawley male rats weighing 300 to 350 randomly into two groups. After burning dorsal skin of rats in the first and the second group, their dressings were changed every three days with AgiCoat and Acticoat respectively. After 14 days, we sent blood samples taken from heart, liver, kidneys, lungs and brain and a sample from dorsal skin of the rat to the lab in order to do histopathological examinations. Then the data were analyzed using by SPSS software, version 20 and onesample, independent-sample test and ANOVA.Results: The results of this study showed that the level of silver serum per Microgram per Liter in the Agicoat group was 17.644±20.371 and in the Acticoat group was 21.800±12.199 and was a significant difference (Agi Coat=0.017) (Acticoat=P<0.001). However, in terms of silver serum levels in two groups, there was no significant difference (P=0.551). Examination of The relationship between the level of silver serum and histopathological changes in liver showed that hepatotoxicity of Agicoat compared to Acticoat was higher and the different was significant (P=0.002).Conclusions: These dressings can cause toxicity and liver pathology. Although it does not seem only dressings cause this problem. Other factors such as weight, host resistance, immune system and etc should be considered important. Since the increase in blood silver would lead to an excessive injury, we recommend further studies on these dressings and similar products.

Introduction & Objective: Hemorrhoid surgery is one of the most common diseases in the anorectal region that can show by pain and bleeding and a mass exit from the anus and one of the main reasons that make the patient avoid surgery is afraid of the pain. Control the postoperative pain especially in the first 24 hours in addition to increasing patient satisfaction will also lead to a decrease urinary retention and constipation and reduce pain from surgery will be more patient welcoming. Study presented to examine the effect of Pudendal nerve block on pain relief after surgery in both groups blocked with general anesthesia and general anesthesia alone.Materials & Methods: In a successive clinical trial of patients undergoing perianal surgery 42 patients with a mean age 35.40 years who refer by happened to Bu Ali, Resalat and Milad Hospitals in Tehran were randomly divided into two groups nerve block with general anesthesia (n=21) and general anesthesia alone (n=21). in the first group was performed General anesthesia and nerve block and in the second group was performed under general anesthesia alone then the test scores of 6 and 24 hours after surgery was calculated with using a pain scale chart in each group. Values obtained were compared with Square- Chi test and the results were evaluated.Results: The mean pain scores at 6 and 24 hours after surgery under blocked and general anesthesia group were respectively 2.4, 2.7 and in the general anesthesia group alone were respectively 3.23 and 3.05.P value equal to 0.004 and 0.048 in the two groups above hours and for comparison of the two groups was 0.05.Conclusions: In this study, the pudendal nerve blocks cause significant pain relief after the first hours after the hemorrhoidectomy operation.

Introduction & Objective: Cholecystitis is one the most common disease in gastrointestinal tract which can be presented as acute or chronic cholecystitis. Several environmental, pathological and physiological factors cause this disease.On the other hand gall bladder carcinoma 2-4 percent of gastrointestinal tract malignancies included, that prevalence in 1 to 2 percent of patients who have cholecystectomy. The outbreak and epidemiologic features of chilecystitis has changed clue to revolutionized style of living. The purpose of this study was to investigation of prevalence of acute, chronic of this disease and gall bladder carcinoma and relation with envirement and physiological parameter patient who have cholecystitis.Materials & Methods: The patient who operated of cholecystectomy in 1394 in Amiralmomenin Hospital of Zabol with diagnosis of cholecystectomy were selected and assessed. The patient were divided into acute, chronic and gallbladder carcinoma groups based on their surgical and pathological finding and patient information records. The data analyzed by using SPSS.Results: 271 patients in the study were evaluated 199 (73.4%) patients were women and 72 (26.6%) patients were men and also 131 (48.3%) patients were living in the villages while 140 (51.7%) patient were living in the city.142 (52.4%) patients were chronic cholecystitis and 129 (47.6%) patients were acute cholecystitis and 8 patients were gall bladder carcinoma. Gallbladder carcinoma was higher in women (60%). The highest incidence of the gall bladder carcinoma were between 40-50 years (24.7%). The Prevalence of cholecystitis were significant relationship with sex and age.Conclusions: According to this study age, sex and living place is effective in present of cholecystitis (acute, chronic, gallbladder carcinoma).This could be related to hormonal differences personal activity due to the diversity of urban and rural life. In the most patient of gall bladder carcinoma, carcinoma occurs with manifestation of gall stone. So maybe prophylactic cholecystectomy be useful for chronic gall stone.

Introduction & Objective: The purpose of this study was investigating the role of perceived social support and its component in explaining the psychological well-being and the marital adjustment in the women who undertake mastectomy.Materials & Methods: The research was descriptive and correlational. The study population included 134 women who attending an outpatient clinic for mastectomy in Isfahan city. The participants completed Ryff's Psychological Well-being Scale (PWBS), The Multidimensional Scale of Perceived Social Support (MSPSS) and Dyadic Adjustment Scale (DAS). Data was analyzed by Pearson correlation regression analysis.Results: The results showed that the perceived social support can predict the psychological well-being and marital adjustment in women undertake mastectomy. Also, there were a direct relationship between well-being and marital adjustment. And data analyzed showed a significant positive predictors of social support is also predict efficacy of psychological well-being in Two areas (positive relationship with others& personal growth) As well as the relationship between marital adjustment and positive psychological well-being was found.Conclusions: This research showed the effective role of social support on prediction of psychological well being and marital adjustment in the women with breast cancer which should be considered in therapeutic counseling and therapeutic services.

Introduction & Objective: Pain on mid-sternotomy incision site after Coronary Artery Bypass Graft Surgery (CABG) is a common problem has a negative effect on quality of life and follow-up treatment. Thus the present study aimed to determine the effect of light massage therapy by patient's Light Pressure Stroking Massage Therapy on Patients' Satisfaction and Quality of Pain Control in post-CABG patients.Materials & Methods: In this semi - experimental study, 72 post-CABG patients were randomly divided into an intervention and a control group. The intervention group received Light Pressure Stroking massage by the nurse for 20 minutes in 4 sessions. The control group received routine care. Patient’s satisfaction and quality of pain control were assessed by brief pain inventory (BPI) and Idvall quality of life questionnaire before and after the intervention. Then, the data was analyzed by student t-test, paired t-test and chi-square by SPSS software version 18.Results: Mean (SD) scores for Satisfaction and Quality of Pain Control before the intervention in the case group were 5.402±1.601 and 49.324±2.569 and in the control group were 4.452±2.123 and 48.425 ± 2.505 respectively, that did not show a significant difference (P>0.05). After the intervention, Mean (SD) scores for Satisfaction and Quality of Pain Control in the case group, were 8.402±1.200 and 64.612 ± 2.004 and in the control group were 5.321±1.500 and 51.513±2.234 respectively, that showed a significant difference (P<0.001).Conclusions: Regarding the finding of study, use of Light Pressure Stroking massage therapy can increase Patients' Satisfaction and Quality of Pain Control of patients after coronary artery bypass surgery and due to low cost and simplicity of this method, it can perhaps be used as a complement to drug therapy and postoperative interventions used in these patients.

Treatment of acute abdomen including acute cholecystitis in pregnant women has been controversial.Although recent advances had resulted in increasing use of laparoscopic procedures in these patients, however, based on anatomical and physiological changes in pregnancy, many surgeons are concern with laparoscopic cholecystectomy (LC) in high gestational age. In current manuscript, we report a 25 years old pregnant female with acute cholecystitis and pancreatitis at 34 weeks of gestational age underwent medical treatment for pancreatitis followed by LC. The general status of the mother and infant are satisfying after 3 years follow up.

Elstofibroma dorsi is a benign and rare tumor that grows in dorsal aspect of thoracic cage muscles. In some patients this occurrence is bilateral. We present a 62 years old farmer man who referred due to a mass in dorsal part of right hemi thorax and inferior to scapula. After pathologic and radiologic evaluation an approximately 6×6 cm tumor was resected with free pathologic margins that final pathologic report was compatible with elastofibroma dorsi. Nearly after one year another tumor appeared in symmetrically in left side beneath scapula that the diagnosis of elastofibroma dorsi was assumed by CT and MRI. Patient was asymptomatic so follow up and observation selected for patient.

Contemporaneity of sigmoid volvulus, considered as one of the bowel obstruction causes and diaphragmatic eventration that each of them are not so common entities, is extremely rare. Sigmoid volvulus is a condition in which a loop of sigmoid colon twists around its mesentery and recurrent type of that is a clinical entity characterized by recurrent episodes of partial or complete sigmoid volvulus. It can be demonstrated from being asymptomatic to abdominal discomforts, nausea, vomiting and constipation.Iran has also been located in the "volvulus belt" region. Diaphragmatic eventration is a structural disorder affecting its natural function and predisposes to push toward viscera into thorax. We are reporting a case of recurrent sigmoid volvulus in a 65 year old man who had contemporaneously left hemidiaphragm eventration so that during operation a loop of gangrenous sigmoid was found into his left hemi thorax.

Introduction & Objective: Developing the use of statistical process control (SPC) methods for the healthcare area is evaluated as an attractive contribution. Analyzing patient data using SPC approach plays an important role to monitor effectively a health care process, improving the quality surgical processes, and other medical service processes. Among SPC methods, cumulative sum approach have been attracted more attention in the medical literature due to its simple formulation and interpretation, as well as more sensitivity to detect medium and small shifts compared to other methods. The aim of this study is to provide analytically positive effects of using CUSUM charts for hospitals, surgical, and therapeutic processes.Materials & Methods: This study is a comprehensive literature review. This paper investigates comprehensively researches and results of the used CUSUM charts in different areas of healthcare focusing on reported reliable scientific sources without any limitation of time.Results: This study reveals that different cumulative sum control chart types are proposed to use in therapeutic and surgical processes leading to improvement of the processes. The analysis indicates that risk adjustment methods considering patients’ risk before surgery is more superior compared to other CUSUM types. This approach focuses on homogenizing and adjusting the effect of physical and physiological conditions corresponding to patients.Conclusions: Cumulative sum charts should be used considering strength and weakness points of each chart as well as data probability distribution. This paper reveals that the use of risk-adjusted cumulative sum charts can be more accurately reflect the performance results of a surgery compared to other chart types. Furthermore the use of CUSUM methods for learning curves is capable of monitoring effectively the performance of medical trainees.

Introduction & Objective: Operating room (OR), is an isolated, secured, specialized and Holy environment in which, surgical patients are accepted, operated, and managed with highest dignity, respect and compassion. Ethical and professional issues pertaining to anesthesia, surgery, and optimal care of patients at OR, are unique, critical and controversial. Defining, approving and application of surgical codes of ethics, professional principles and moral values is mandatory in situations specific to OR. Unethical and unprofessional behavior, in any form or by any means, is forbidden by all members of OR team. This article reviews these priciples with respect to all pertinent processes in OR during the preoperative, intraoperative, postoperative periods.Materials & Methods: The study designed and conducted by an expert group of ethics committee of Iranian Surgical Association and were further enhanced by internal and external experts. Lists of relevant ethical issues were developed by literature review of recent 3 decades, and ordered in main categories by focus group discussion.Fundamental ethical and professional principles, accepted and preferential moral values, and unethical behaviors, were established and arranged in order of priority.Results: We identified 14 main categories of fundamental ethical and professional principles, 237 preferential issues, and several important sub-topics. Main categories are as below: 1.OR ethics organizational structure 2.Fundamental ethical principles and moral values 3.Fundamental ethical practice of anesthesiology in OR 4.Fundamental surgical ethics in OR 5.Interprofessional collaboration and communication in OR 6.Surgeons and Anesthesiologists common ethical and professional responsibilities in OR 7.Ethical and professional responsibilities of OR nursing 8.Technician duties and and professional ethical responsibilities in OR 9.Standards of practice, Legal and Professional aspects of OR duties 10.OR safety and guideline of safe surgery: ethical and professional obligations 11.OR conflicts: roots, prevention, mamagement strategies and instant value-based resolution 12.Ethical principles special to residency education at OR 13.Principles of ethical and professional cpnduct in different surgical disciplines 14.Ethical aspects of surgical research at OR Each main category followed by a list of relevant, specialized codes, ethical principles, moral values, professional regulations, or other topics, and was concluded at discussion section of the article.Conclusions: Recognition and regard the principles of surgical ethics and professionalism have become a central area of attention by Iranian Surgical Association. This study is a guide to widely accepted recommendations, applicable in anesthesiology, general surgery, nursing, technicians, and various other surgical and anesthesiology disciplines, as well as other OR team members.