Iranian Journal of Surgery
Year:2018 | Volume:26 | Issue:1 |Papers Count:17

Gastrointestinal bleeding is a common problem and yet sometimes difficult to manage. It could be occult or overt, and may start in any part of the gut. The source of bleeding could be in upper (UGIB) or lower (LGIB) or less likely the small bowel (MGIB); which can become obscure and difficult to find the source. In the past few decades, many drugs has become available for acid suppression and thus prevention of bleeding and at the same time patient especially the elders use ulcerogenic drugs such as analgesics, NSAIDs, SSRIs and different anticoagulants for their accompanying illness which makes the treatment decisions precarious. Most bleeders stop spontaneously and only 15% need urgent resuscitation and intensive treatment of these only 5% need surgical intervention; which are usually the aged with severe comorbidties.

Introduction & Objective: Each toxic agent results in unique presentations, depending on what neurophysiological changes occur following exposure. Lead poisoning can lead to various signs and symptoms. The aim of this study was to evaluate the abdominal pain characteristics of patients with lead poisoning referred to Loghman Hakim Hospital in Tehran during 2016-2017. Materials & Methods: All patients with lead poisoning were referred to Loghman Hakim Hospital in Tehran from April 2016 to September 2017 undergoing surgical consultation Were Evaluated. Information was recorded in a researcher-designed questionnaire. The questionnaire included demographic information (age, sex, education, occupation) history of previous illness, history of addiction (type of substance, drug use method, duration of drug use), abdominal examination, blood lead level, hemoglobin, and results of paraclinical measures Plain abdominal geraphy. Data was analyzed using SPSS 16 soft ware. P value less than 0. 05 was considered significant. Results: A total of 200 patients were diagnosed with lead poisoning based on history and serum lead levels were evaluated. Of these, 184 were males (92%) and 16 were females (8%). The mean age of the patients was 48 ± 4. 5 (mean ± SD). Abdominal pain was more common in peri-umbelical, the nature of pain was severe, usually without radiation, exacerbation with eating, non-response to analgesics and the most associated with constipation. Conclusions: Abdominal pain was more common in peri-umbelical, the nature of pain was severe, usually without radiation, exacerbation with eating, non-response to analgesics and the most associated with constipation.

Introduction & Objective: Infectious complications of intramuscular injections in the gluteal region are still noticeable. Gluteal abscess formation after injection is more important because of probably need to surgical incision and drainage. There are several factors that cause the formation of abscess due to injection in gluteal area that controlling of them can play a role in preventing the occurrence of abscess. Materials & Methods: The aim of this study was to investigate the demographic and clinical features of patients with gluteal injection abscesses. 125 patients who had undergone incision and drainage due to were included in the study in hospital centers of Babol University of Medical Sciences during 2004 to 2017. The data consist of demographic features, injected drug type, abscess gram stain and culture were collected and interpreted by SPSS v 20. Results: Of the 125 patients studied, 48 (38. 4%) were male and 67 (53. 6%) were female. 40 patients with BMI less or equal to 30 and 85 had a BMI of over 30. NSAIDs were most injected agents. The duration of hospitalization was 1 to 3 days after surgery and the average of wound healing time was 15 days. Conclusions: In this study, female sex and obesity were two factors that were more associated with the incidence of injection site abscesses. More attention is paid to the proper technique and the choice of injection needle size appropriate to each patient is one of the factors that can prevent the injection site abscess.

Introduction & Objective: Appendicitis is one of the most common operations in general surgery. The best way of diagnosis based on clinical view. Early diagnosis and operation on time reduce complications obviously. In this study the best clinical view of appendicitis investigated and recommended. Materials & Methods: In a cross sectional study all patients suspected to appendicitis that referred to emergency department of Nekui-Hedayati hospital of Qom and managed with one surgeon included to study. Decision making for diagnosis and operation based on clinical symptoms and signs. Data was analyzed with chi-square test in SPSS 20. Results: Of 127 patients 109 p. (85. 8%) had clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness. Normal appendectomy was 13. 4%. on the base of pathology of 109 p. with clinical triad 98 p. (89. 1%) had appendicitis with sensitivity of 89. 1%, accuracy of 81. 9%, positive predictive value of 89. 91% and odd ratio of 4. 45% (Confidence Interval 95% = 1. 395 – 14. 229). Conclusions: Clinical triad of abdominal pain, shifting pain to RLQ and RLQ tenderness is the best clinical view of appendicitis and can done operation without any delayed time.

Introduction & Objective: Breast cancer is one of the most common cancers in women throughout the world including Iran. There are currently more than 40000 women in Iran suffering from the disease. Studies have shown that the active form of vitamin D, increases cell differentiation and inhibits proliferation, can play a role in changing the risk of breast cancer. Materials & Methods: Present study is analytical and case-control study. In this study150 women with breast cancer and150 women without breast cancer as control were investigated. Including criteria was diagnosis of breast cancer in all cases and absence breast cancer in all control group. Serum vitamin D level, age and marital data included in check list. The obtained data were subjected to chi square, logistic regression and two samples t-test by SPSS software version 23. In all analyses P ˂ 0. 05 were as significant difference. Results: Mean level of serum vitamin D in case and control groups were 16. 73 ± 11. 95 and 27. 04 ± 18. 49 ng/ml, respectively (P < 0. 001). Based on multivariable analysis of logistic regression, the risk of developing breast cancer increased with a decrease in serum vitamin D levels. At the level of vitamin deficiency (10 > ng/ml), the odds ratio of illness were 1. 93 times higher than the inadequate level. (%95 CI: 0. 281; 0. 954, P = 0. 035), and the odds ratio of getting the disease were 6. 9 times higher than the adequate level of vitamin D (%95 CI: 0. 075; 0. 361, P < 0. 001). Also, the serum vitamin D level with estrogen receptors and progesterone receptors was significantly correlated (P < 0. 001), but there was no significant correlation with HER-2 receptor (P = 0. 195). Conclusions: Based on this study, patients with breast cancer had significantly lower levels of serum vitamin D in comparison with healthy women. Therefore, decreases in serum vitamin D levels are associated with an increased risk of breast cancer.

Introduction & Objective: Postoperative surgical adhesion is a common consequence of intraperitoneal surgery which may lead to several complications such as adhesive small bowel obstructions, chronic abdominopelvic pain, and female infertility making a significant adverse impact on health care costs. Many efforts have been made aiming to decrease the rate of postoperative surgical adhesion formation. We conducted the present experimental study aiming to evaluate the effectiveness of sodium hyaluronate, sesame oil, honey, and silver nanoparticles in preventing of postoperative surgical adhesion formation. Materials & Methods: Our study was conducted in Hamadan University of Medical Sciences, Hamadan, Iran during 2015 and 2016. Forty male Wistar rats were randomly assigned into five groups with eight rats in each group including control, hyaluronate, sesame, honey and silver groups. They were housed in 21° C temperature and 60% ± 5 humidity. After two weeks the animals underwent laparotomy and were evaluated by two different blinded surgeons for severity of adhesions based on the two different classification scoring systems including Nair classification and cumulative adhesion scoring scale. Statistical analyses were performed by using SPSS software (IBM SPSS Statistics for Windows, Version 20. 0, IBM Corp., Armonk, NY, USA). Quantitative and qualitative data were analyzed using the Kruskal-Wallis and Mann-Whitney U test, respectively. Statistical significance was defined by (P < 0. 05). Results: The scores of severity of adhesions in the hyaluronate and sesame groups were significantly lower than the control group based on the Nair classification (both P-values = 0. 02), however based on the cumulative adhesion scoring scale just the score of severity of adhesions in the hyaluronate group was significantly lower than the control group (P-value = 0. 02). In the hyaluronate group the severity of adhesions was decreased by 48% based on the cumulative adhesion scoring scale. Conclusions: Sodium hyaluronate and sesame oil may have a significant effect in preventing postoperative surgical adhesion formation.

Introduction & Objective: Although blood transfusion is life saving for obstetric and gynecologic patients, it is costly and can result in series of adverse reactions if transfusion not done rationally. The aim of this study was to evaluate blood products consumption in obstetrics and gynecologic patients and measurement of Crossmatching to Transfusion (C/T) ratio. Materials & Methods: This was a retrospective descriptive study conducted among 1214 women who receive blood products at the Al-Zahra teaching hospital in Rasht, during the 3 years period from March 2011 to March 2014. The collected data include demographic data, cause of admission, before transfusion hemoglobin and hematocrit and number and type of transfused blood products were analyzed with SPSS version 19. Results: Only twenty-six percent (2804) of requested and cross matched blood products (10824) transfused. Crossmatching to Transfusion (C/T) ratio was 3. 9 and Hemoglobin and hematocrit mean values before Red Cell Concentrate (RCC) transfusion were 8. 3 ± 1. 7 g/dL and 27. 4 ± 4. 8 % respectively. 25 percent of patients received only one unit of RCC. Conclusions: Due to high C/T ratio and RCC transfusion indexes, it seems that requisition and consumption of blood products are exceed the necessary amount and it seems essential to evaluate its causes accurately to provide appropriate clinical practice guidelines.

Introduction & Objective: The field study is based on a special emphasis on the scientometric concepts that surgeons can take advantage and this study aims to introduce more scholars and experts in the field of surgery and its indicators. Materials & Methods: The method of study of this library research was the concept of scientometrics and effective indicators and used in the field of scientometrics using resources Different have been studied. Results: The Measuring science and production in the country is still in its infancy, and so far has not been able to pursue a coherent and purposeful activity. Scientometrics activities in the country are generally or by using indicators that are either based on research findings or that are performed using indices from other countries. However, in the framework of many centers and organizations, there are missions that are inevitable to carry out the assessment and evaluation of scientific production at the inter-organizational level, and even at the national level. Conclusions: The present paper is an invaluable resource for responding to all those who deal with Scientometrics concepts and, in general, science. Researchers in different fields, especially the surgical field, should be familiar with what their scientific products are examining. In order to improve the scientific production as well as to resolve weaknesses and strengthen their strengths.

Mucocele formation is a pathologic condition that usually occurs in organs with secretory and glandular tissue such as sinuses, lacrimal glands and ducts, appendix, intestine and … Mucocele in the abdominal wall is a very rare condition and is of importance to be considered in differential diagnosis. In this article we present a 60 years old woman with abdominal wall mucocele in the previous colostomy site.

We present an 8-year-old girl presented with rectorrhagia that started since 3 months and misdiagnosed with infectious diarrhea. A few months later, colonoscopy revealed a non-pedunculated polyp and was resected. After the colonoscopy the patient had presentations of peritonitis and rectal perforation was noted in laparotomy. The result of rectal biopsy was adenocarcinoma. Surgery consultant decided to perform a low anterior resection of rectum, ileostomy and the treatment continued with chemotherapy. After 19 month’ s follow-ups the patient was alright without any clinical, radiological or laboratory signs or symptoms of tumoral recurrence. As the manifestations of rectal adenocarcinoma are not specific, the clinicians should consider it in the differential diagnosis of gastrointestinal problems.

Laparoscopic procedures have been widely accepted worldwide. During recent years, many procedures have been introduced laparoscopically. Pancreaticoduodenectomy is one of the complex procedures in abdominal surgery. Because of complexity of this procedure, its laparoscopic form has not been performed frequently. To our knowledge, totally laparoscopic Pancreaticoduodenectomy has not been reported in Iran. The following case demonstrates first totally laparoscopic Pancreaticoduodenectomy in Iran. A 57 year-old woman was admitted in surgical ward of Shahid Modarres hospital, Tehran, Iran, with icterus and abdominal pain. Diagnostic evaluations revealed Periampullary adenocarcinoma. After appropriate preoperative measures, she underwent totally laparoscopic Pancreaticoduodenectomy. The postoperative period was uneventful and patient discharged on the 8th postoperative day. Histopathological evaluation confirmed the diagnosis of Periampullary adenocarcinoma. Totally laparoscopic Pancreaticoduodenectomy is one of the complex laparoscopic abdominal procedures, which had not already been performed in Iran. Because of advantages of minimally invasiveness and lesser postoperative pain and shorter hospital stay, it can be recommended in selected cases.

One of the relationships that have legal effect, through which there are various cases in the judiciary, including the prosecutor's office and the court, is the relationship between the surgeons and the patient. This relationship is important because it has important legal effects. Before modern lawmaking in Iran, this relationship was discussed in sources of jurisprudence and the relationship between doctor and patient was investigated in various jurisprudential books. After the introduction of modern lawmaking, various laws were introduced to regulate the relationship between the doctor and the patient, and these laws have been subject to various changes and changes. The last legislative changes in the Islamic Penal Code were adopted on February 1, 2013 and made changes in this regard. Along with the Islamic Penal Code, the Family Protection Act of 1392 has also introduced regulations in this regard. The Civil Liability Act of 1339 is also recognized as the general law of one of the sources of the relationship between a doctor and a patient. The aim of this study was to investigate the relationship between a surgeon and a patient physician based on the latest legislative changes, and according to the results, new laws were more appropriate to surgeons than past laws due to the importance of medical care.