Iranian Journal of Surgery
Year:2014 | Volume:22 | Issue:1|Papers Count:18

Breast cancer is the most common malignancy in women and it is also the leading cause of cancer death in women worldwide. The incidence of this disease is increasing particularly among women aged 50-64. It is the most common malignancy among Iranian women over the past decades and it is spreading rapidly. Sarcoma of the breast is rare. It can occur primary or secondary way. Primary sarcoma’s occurrence in breast is extremely rare and is a highly aggressive tumor. 5.7% of the primary breast sarcomas are Angiosarcoma. Secondary sarcoma is developed after breast irradiation for a previous breast carcinoma, associated with poor prognosis. Angiosarcoma is 56.8% of all breast sarcomas. The main diagnosis of breast Sarcoma is fine needle aspiration (FNA). Imaging can also be helpful. Course mammography in breast sarcoma is nonspecific but as a better method of ultrasonic mammography in detecting breast sarcoma it is proposed to treat breast sarcoma total mastectomy is the most common procedure in which the entire breast is removed, but the lymph nodesare notremoved. An adequate resection margin is the single most important determinant of long-term survival with breast sarcomas. As with soft tissue sarcomas arising elsewhere in the body, the prognosis for breast sarcomas is highly dependent upon histologic grade and tumor size.

Introduction & Objective: Abdominal trauma is one of the major causes of mortality in human populations. The aim of this prospective study was to evaluate the predictive value of sonography versus CT scan in the detection of renal injuries in patients, with high energy blunt abdominal trauma and microscopic hematuria, who referred to emergency department of Shohadaye Tajrish hospital.Materials & Methods: This study included all 400 patients (279 males and 121 females), with 15-65 old ages, who referred to the emergency department of Shohadaye Tajrish Hospital for high energy blunt abdominal trauma, between 2010 and 2012. Patients with gross hematuria, hemodynamic instability, past medical history of renal failure, contrast agent allergy, renal failure, pregnancy and other contraindication of contrast injection were excluded. Personal characteristics of the patients such as age, sex, cause and mechanism of trauma, severity of trauma and physical examinations were recorded. Then all patients were evaluated underwent, separately abdominal and pelvic spiral CT scanning with intravenous contrast and abdominal sonography by an experienced radiologist. The positive and negative results of sonography were compared to the findings of abdominal and pelvic CT scan, as a gold standard procedure.Results: Of the 400 patients (with the mean age 25.9±14.1 years) who were admitted to the emergency department due to high energy trauma, renal damage was detected in 68 cases by CT scan (17%). In 8 patients (11.8%), bilateral renal injury and in 60 patients (88.2%) unilateral renal injury was identified. According to the grading classification proposed by the American Association for the Surgery of Trauma (AAST), the severity of injury (in 76 kidney) were diagnosed, by CT scan as grade І, ІІ, ІІІ, in 49 (64.5%), 20 (26.3%) and 7 (9.2%) respectively. According to ultrasonography results, renal damage was found in 61 cases (15.2%). Signs of sub-capsular hematoma, laceration, perinephric hematoma and parenchymal hematoma were detected by ultrasound in 37 (55.2%), 25 (37.4%), 3 (4.4%) and 2 (3%) respectively. Overall sensitivity and specificity of sonography versus CT scan in the detection of renal injury were calculated to be 52.76 (68.4%) and 309.324 (95.37%), respectively, with a 52.67 (77.6%) positive predictive value and a 309.333 (92.7%) negative predictive value.Conclusions: Generally, according to the results of this study, the role of sonography as one of the primary diagnostic technique for the detection of renal injury, in the patients who are affected by high energy trauma and microscopic hematuria and with stable vital signs, is confirmed.

Introduction & Objective: In recent years the use of diced cartilage grafts in rhinoplasty have been considered by most plastic surgeons. For preventing dispersion of diced cartilages, many authors recommend the use of various wrapping such as temporalis fascia, surgicel or alloderm to cover diced cartilage grafts. The aim of this study is to compare the absorption rate and viability of cartilage autograft between two groups of unwrapped and fascia wrapped diced cartilage graft.Materials & Methods: In this study, 15 rabbits, of age between 12 to 16 weeks of age were used. One ear of each rabbit was excised and denuded of skin and perichondrium, then it was divided into two equal pieces and were diced. One group of the grafts were covered by rabbit fascia Lata and the other group left was without coverage. Two subcutaneous pockets were created on each side of lumbar vertebrae. After precise weighing of specimens, wrapped and unwrapped diced cartilages were implanted into separate pockets on the each side rabbit vertebra coloumn. After 12 weeks, the grafts were removed and weighed precisely and samples were stained with H&E and were examined histologically by pathologit.Results: The absorption rate of fascia wrapped diced cartilage grafts was significantly more than the case of unwrapped diced cartilage grafts (P-value<0.001). Unwrapped diced cartilage graft had some growth, but it wasn’t statistically significant (P-value=0.09). New cartilage formation in the unwrapped group was significantly more than the case of fascia wrapped group (P-value=0.001). But in terms of cartilage integrity, cartilage viability, fibrosis and ossification no significant difference was found between two groups.Conclusions: Our study objectively proves that wrapping around implanted diced cartilage graft may act as a barrier and impedes nutrients to reach to the chondrocytes. Since there was no resorption in the unwrapped diced cartilage group, we recommend it as a good method for restoring profile in rhinoplasty surgery.

Introduction & Objective: Cervical laminectomy is a well-known and standard procedure for the treatment of cervical myelopathy due to degenerative narrow cervical canal. There are many different reports about the incidence of post laminectomy kyphosis in the literature and the causes are not well understood.Materials & Methods: This study was done in a retrospective/prospective manner, reviewing the files of the patients operated by cervical laminectomy between1377-1387 and following them prospectively. The demographic data is presented. The cervical alignment in neutral and dynamic situations and pre/post operative neurological conditions will be compared.Results: In this study, the incidence of post laminectomy kyphosis was 11.9%, which was less than what was reported in other series. The decrease of cervical alignment was not significantly related with the degrees of preoperative cervical alignment, but the neurological improvement rate was correlated significantly with post laminectomy alignment. Cervical pain was correlated significantly with the increase of age, osteoporosis and cervical alignment. The incidence of kyphosis increased with more long term follow up.Conclusions: The incidence of post laminectomy kyphosis in the patients operated for degenerative narrow cervical canal is less than what happens in the patients undergoing laminectomy for other reasons (11.9%). The incidence of kyphosis increases with longer periods of follow up and is accompanied with lower rate of neurological improvement. Accordingly, these patients need longer periods of follow up.

Introduction & Objective: Nerve injuries resulting from major or minor trauma, often cause some disabilities for the patients. Neurotmesis which is characterized with a complete anatomical rupture of the nerve is the most severe form of the injury that would not recover without reconstructive surgery. Nowadays such neural damages are improved by microsurgical procedures. Some studies have used low power lasers in nerve cell’s growth in order to improve the peripheral nerves’ rehabilitation results. In fact, low power laser can be a beneficial complement in the reformation of post surgical nerve injuries. This study’s goal is to find the effects of lasertherapy after the constructive surgery of median nerve rupture in the distal half of the forearm, and to compare the results with the standard method.Materials & Methods: This study is a case-control clinical trial of 36 patients with volar surface rupture of the distal half of forearm who had been admitted to the emergency ward of Hospital within 72 hours of trauma and in examination they had paresthesia in first, second and third fingers as a result of median nerve injury. Patients were divided into two groups. The first group included patients who had been treated with standard methods and second group includes the ones who had taken low power laser along with standard method. The two groups had gone through the surgery by the same surgeon. The second group took 10 sessions of lasertherapy every other day. Clinical Examination, myelography and nerve conduction velosity was done at the third week, third month and the sixth month and the results were compared with each other.Results: The two-point discrimination test of the index finger had a prominent result in laser group compared to the control group and NCV and EMG findings of the motor section had a significant statistical difference. This showed preference of the laser group over the control one and this was compatible with our physical exams. First finger opposition and abduction too had improved in the laser group as compared with the control group.Conclusions: Accordingly, Laser therapy in our protocol, Laser therapy seems to have an effect on some of the nerve growth parameters and this is mostly on motor fibers, rather than the sensory ones.

Introduction & Objective: Postopertative pain management is still one of the topics of interest to the anesthetists and surgeons. Postoperative pain has a direct role on the excess hospital stay, and that leads to more morbid complications and extra hospital costs. This study evaluates the efficacy of gabapentin on the control of acute postoperative pain.Materials & Methods: 90 patients who were scheduled for elective laminectomy were randomly allocated into three groups. Group 1 received 800 mg gabapentin and group 2 400mg gabapentin and group 3 took placebo 2 hours before surgery. Post operative pain was measured in 48 hours after surgery, using Visual Analog Scale (VAS), and also the mean consumption of opiod and the mean painless period after surgery were measure and compared.Results: The mean of age, weight, and sex and operation time was not significantly different for the three groups. The VAS score was significantly different between the groups (P=0.000), with lowest score in group 1 (6.27) and highest score in placebo group (8.20). The mean of consumption of opioid in group the 1 (800 mg) was 5.6 mg, and that was lower than other groups. On the other hand, the onset of pain was significantly different between group 2 and 3 (P=0.309).Conclusions: The dose of 800mg gabapentin, 2 hours before laminectomy operation is, more effective in reducing postoperative pain, the need for opioid and the increase in the duration of painless period after surgery than the dose of 400 mg. Therefore, it is necessary to evaluate more prospective controlling studies to compare different doses of the gabapentin, other medications on the controlling of pain and the evaluation of their side effects.

Introduction & Objective: Several positions are proposed for the radiography of lateral spine. Although clavicle position is currently taken as the standard method to obtain lateral spine view in most spinal surgery departments, but some centers still apply the traditional 90° position. The aim of our study is to compare the effects of these two common positions on the determination of kyphosis or lordosis degrees, the vertebral landmarks, and the global sagittal balance.Materials & Methods: By a diagnostic evaluation study, 50 patients with different indications for total spinal lateral view were studied by taking this view in two positions: Clavicle position and 90o (Straight out) position. The investigated items were: thoracic kyphosis and lumbar lordosis degrees, global sagittal balance, the clarity of T2 and T12 vertebrae and the L5-S1 disc. The radiographs were interpreted by two fellows of the spine surgery. Statistical analysis was done by t-test and Wilcoxon test.Results: The clarity of T2 vertebrae in the position 90° was significantly better than the case of Clavicle position (score 23 vs. 16). T12 vertebrae Image resolution was better in Clavicle position (score 8.5 vs. 11). The difference of L5-S1 disc clarity in the two positions was not significant (score 10.1 vs. 10.8). The averages of kyphosis (35° vs. 38o) and lordosis (both 24o) were not appreciably different. Our note worthy finding was the positive increase of the sagittal balance in the 90o position.Conclusions: In order to determine sagittal balance in the lateral X-Ray of spine, the Clavicle position is more accurate than the 90o position. While the Clavicle position provides adequate visualization of most vertebral landmarks, its ability in the regional curve measurements is not significantly different from that of the 90o position.

Introduction & Objective: Urinary catheters are different and each one is made for a specific purpose. Some patients have urinary catheters for long stays in their bladder, so its complications must be evaluated. In this study, the effects of two types of urinary catheters on the rabbit bladder pathology were compared.Materials & Methods: It this study a total of 20 New Zealand rabbits were randomly divided into 2 groups of 10 rabbits. Under general anesthesia, and following a lower midline incision, bladder was exposed and in groups 1 cystostomy with Nelaton catheter in 10 rabbit was performed and 10 other rabbits in groups 2 were placed under Systostomy with Foley catheter. 7 days after the surgery, a re-laparotomy with isolation of rabbit bladder tissue was performed for pathological assessment. All data extraction was done by 17.0 SPSS software. Statistical tests such as Chi-square, Fisher's exact test, and Mann-Whitney tests were used for data analysis. P-value ≤0.05 was considered significant.Results: In both the Foley and Nelaton catheter groups, the highest frequency intensity in inflammation was of grade 3. Although the group with a Nelaton catheter had more inflammation than Foley catheter group but this difference was not significant (P>0.05). The samples of inflammatory cells were different from 5 to 80 percent. In Nelaton and Foley catheter groups, the highest frequency of five to ten percent of PMN was seen. The difference between the two groups in the mean severity of bleeding was not significant (P>0.05). Foley catheter had less chance of infection than Nelaton catheter. Although the differences observed in the two groups was not significant in the chi-square test (P>0.05).Conclusions: A comparison of the severity of inflammation, inflammatory cells, bleeding in the tissues of the bladder in pathological assessment and urinary tract infection demonstrated no significant difference between Nelaton and folly catheters. This indicates that none of the above two types of catheters had any particular preference.

Introduction & Objective: Due to the growth in the prevalence of Coronary Artery Bypass Graft (CABG) surgery and the significant role of self efficacy on the quality of life and prognosis and relapse of cardiac disease, the present study was designed to determine the relationship between self efficacy and quality of life of patients undergoing CABG hospitalized in Isfahan Chamran hospital between 2010-2011.Materials & Methods: This was a cross-sectional correlational study. Our sample consisted of 110 patients who had referred to Shahid Chamran Rehablitaion Center and had undergone CABG surgery. Data was collected by General Self Efficacy (GSF) and Quality of Life (SF-36) Questionnaires and they were analyzed by using independent t-test, analysis of variance and regression analysis by SPSS 18.Results: The overall score of the self efficacy in the subjects was 21.23 (10.3) and that of quality of life was 60.06 (16.1). Our results showed that there was a direct relationship between the self efficacy and quality of life, which this means that by self efficacy enhancement, quality of life increases and vice versa.Conclusions: Considering the significant correlation between self efficacy and quality of life in this study, it is suggested that nurses design and execute appropriate interventions to promote these patients’ self efficacy, and in this way help to improve these patients’ quality of life.

Here is a 35 year old with no underlying disease, who referred to hospital within 8 days after blunt trauma in the chest, with a chief complaint about his shortness of breath and hemoptysis. After the paraclinical work up the diagnosis of pulmonary infarct, due to a pulmonary embolus, triggered by blunt trauma in the patient's chest was made. Since over 95% of all pulmonary embolism originate from thrombi in the deep veins of the lower leg and 80-60% of pulmonary emboli are asymptomatic pulmonary embolism in the majority of patients who don’t have history of heart disease, it can only lead to hemorrhage, without persistent pulmonary infarction. As the incidence of this presentation is low, it thus can be considered.

Lung re-transplantation is a technically difficult procedure, but it becomes necessary in some patients with previous lung transplantation. Our patient was a 25 years old man with emphysema and alpha-1 antitrypsin deficiency, and had right side single lung transplantation 6 years ago. After 3 years of first operation pulmonary indexes gradually declined and with the diagnosis of Obliterans Bronchiolitis, he was treated by immunosuppressive medication and antibiotics. But with more decline in pulmonary function, frequent rejections and fibrosis, patient became dependent on supplemental oxygen, and re-transplantation was considered to be the only efficient treatment. Finally patient underwent left side lung transplantation, 6 years after his first lung transplantation.