Iranian Journal of Surgery
Year:2005 | Volume:13 | Issue:34|Papers Count:15

Introduction & Objective: During recent decades thoracic surgery has been separated and developed in Iran as a branch from general surgery. Today, thoracic operations are done by surgeons who are trained for this work and quality of care is comparable to world-wide practice. Having knowledge on this historical process, might be valuable for readers and make them familiar with pioneers in this field and results in to motivation of young surgeons for more development.Material & Methods: Many interviews were done with senile chest surgeons, professors and their families, their personal files and pictures were used and documents from "Educational Secretary – Ministry of Health..." were also used to complete the final text.Results: From the beginning of contemporary solar century (1300), thoracic operations were undertaken occasionally by general surgeons, however, up to the 3rd decade closed circuit anesthesia was not available, formal training of thoracic surgery was not practiced, antibiotics had not been introduced and even there was not any knowledge about modern methods of pleural drainage and chest tubes.Therefore, thoracic operation in that era, was limited to emergency treatment of trauma patients and evacuation of abscesses and infections. Tuberculosis and need for surgical treatment of its complications was an important stimulus for development of thoracic surgery. General surgeons which were graduated in Europe or USA had some familiarity with thoracic surgery and occasionally embarked on these operations In. some Military centers and organizations from foreign countries, thoracic operation were also occasionally done by Iranian or foreign surgeons. Professor "Iahya Adle" were one a pioneer general surgeons who attempted some thoracic operations and trained it to his assistants. In 1330 Dr "Sadegh Ghazi" and soon after, "Dr Anvar Shakki" were invited and employed by "Charity Foundation for Tuberculosis" and began their work in "Boo-Ali Hospital"& "Abo- Hossein Hospital". They were the first surgeons who concentrated their work on surgery of tuberculosis and chest diseases. They had been trained in this field in France. The years of 1330-40 should be known as the beginning of thoracic surgery in these centers. The works of "Ghazi & Anvar Shakki" was extended to other centers including: "Masih Daneshvari" Hospital, "Sorkheh Hessar Hospital", military hospitals and other places. From the beginning of 5thdecade (1340-50) surgeons which had been trained and graduated as thoracic and cardiovascular surgeons in USA or Europe, were employed by Tehran University and other universities.Thoracic surgery became a formal practice and academic educational courses established with contributions of these surgeons. In 1363 General Thoracic Surgery was approved as a postgraduate subspecialty. More than 80 thoracic surgeons have been graduated since then; most of them are active in the field in different cities.Today, Tehran University, Shaheed Beheshti University and Tabriz University are approved to train general thoracic surgeons and in many other universities and non-university centers trained surgeons are active in this field and have established separate departments of general thoracic surgery.Conclusions: Considering the establishment of this subspecialty in our university centers and its scientific development nowadays there is a good opportunity for education and research in this field of surgery in Iran.

Introduction & Objective: Kidney transplantation remains the most effective treatment for children with end-stage renal disease. We analyzed data from the University of Heidelberg transplant programme to present our results on pediatric kidney transplantations over the past 35 years.Material & Methods: From 1967 to 2003, 354 pediatric kidney transplantations were performed at the University of Heidelberg. Data were obtained from the pediatric kidney transplantation records consisting of 291 (82%) cadaver and 63 (18%) living donated transplants. Demographic data, familial relationship of the living donors, surgical technique, immunosuppressive drugs, graft and patient survival rates were assessed.Results: The mean age of cadaveric and living donors was 32.0±17.1 and 37.6±7.5 years, respectively.The familial relationship of the living donors included the mother in 65% of cases, the father in 31%, and other relatives in 4%. In the last 4 years, the respective mean cold ischemia time was 1.6±0.5h for living donated and 13.5±4.1h for cadaveric donors. The mean age of children who received kidneys from cadaveric and living donors was 11.3±4.5 and 10.4±4.5 years, respectively, with a male to female ratio of 57 to 43%. Overall patient survival rates were 95% after 1 year and 89% after 5 years. The patient 5 and 10 year survival rates for living donor renal transplantations were 95 and 95%, respectively. Graft survival rates improved since 1990 compared with the period prior to1990: 82.5 vs 56.7% graft survival at 1 year and 82.5 vs 50% after 5 years (P=0.03). Comparing the operating technique in a subgroup of our patients that received the same immunosuppressive regimen, anastomoses with the aorta and vena cava (51%, n=31) were associated with a graft survival of 86.6 and 83.3% after 1 and 5 years, whereas anastomoses with iliac vessels (49%, n=30) were associated with a graft survival of 55.8 and 51.6% after 1 and 5 years, respectively (P=0.01).Conclusions: There has been a gradual improvement in our paediatric kidney transplantation results over time. Living donor paediatric kidney transplants have higher patient and better graft survival rates than cadaveric donor kidney transplants. Using the aorta and inferior vena cava for graft anastomosis, utilizing newer immunosuppressive drugs and implementing living kidney donation have positively affected the results of our pediatric kidney transplantations.

Introduction & Objective: Pain after posterolateral thoracotomy has long been recognized as a cause of postoperative morbidity, resulting in inadequate ventilation, coughing, atelectasis, mucous plugging, hypoxia and pulmonary infection. Effecious methods of post - operative pain treatment includes: Cryoanalgesia, administration of epidural narcotics and intercostal nerve block and interpelural regional analgesia. The purpose of this study is to evaluate the effectiveness of Bupivacaine infusion through extraplural catheterization for pain control after thoracotomy.Material & Methods: One hundred - six patients undergoing elective thoracotomy that an intraoperatively placed indwelling extra pleural catheter randomly divided in two groups: GI (control): receive 10cc bupivacaine then 0.1m1/kg/h N/S by continues infusion pump and GII: receive 10cc bupivacaine then 0.1 ml/kg/h bupivacaine.Post operative pain was assessed for 72 hours by: linear visual analogue scale and with prince henry scale. Analgesic consumption and food intake were also investigated.Results: Evaluation of VAS showed that the average pain score in 4, 24, 48, 72 hours after operation in GI was 4.6, 6.1, 5.9, 5 and in GII was 4.5, 3.6, 2.5,1.8 (P<0.05) and with prince henry pain score in GI:2.6, 2.8, 2.5, 1.8 and in GII was 2.6, 2, 1.4, 0.8 (P<0.05). The average of food intake in 1 day after surgery in GI was 0.7 was and in 3th days was 1.3 and in GII was 1.3 and 2.7 (P<0.05). There was no complication from the catheter placement and infusion of Bupivacaine in any patient. Conclusions: This study has demonstrated that Bupivacaine infusion through extrapleural catheter was effective for control of pain after thoracotomy without systemic toxicity.

A retrospective study of 31 patients who underwent subclavian flap aortoplasty between 1994 and 2004 was carried out.The patients included 31 children with a median age of 1.3 years, 61.3% of patients were male and 3 8.7% were female.The frequency of associated heart malformation was: PDA (77.4%), VSD (29%), AS (19.4%), MS (9.7%). The patients were followed 1-126 months with median 34 months.Recoarctation occurred in 1 patient (3.2%) who was treated with Balloon angioplasty.No case had acute ischemia or gangrene or left hand malfunction was not seen. There were no paraplegia and bleeding and chilothoracs. The early mortality was 3.2% (1 patient).In conclusion we believe that the surgical repair of pediatric coarctation as soon as possible not only do not increase incidence of recoarctation but also decreases postoperative complications such as hypertension.SCFA remains an effective technique for repair of aortic coarctation with excellent results and low morbidity and mortality.

Introduction & Objectives: Inguinal hernia repair is one of the most common General surgery procedures. Yet, there is still no consensus about the best choice of anesthesia. In this study, we aimed to compare early post operative complications and pain intensity in Lichtenstein hernioplasty by General V.s. Local anesthesia in a teaching hospital, prospectively.Material & Methods: In this clinical trial 120 Patients with diagnosis of uncomplicated inguinal hernia were assigned to have Lithenstein hernioplasty under General or Local anesthesia and compared. Results: There was no difference in local wond complications. Systemic complications (Nausa/vomiting, urinary retention) were detected in 5% and 3.3% of General anesthesia group, respectively, but not in local group. Pain intensity score was low in Local group (VAS=2.4) Than General group (VAS=2.8). But this difference wasn't meaning full statically. Cost of local group was 0.6 of general group.Conclusions: With regard to equal wound complication between two group and, Low systemic complications and also low cost in Local group we recommend routine practice of this method.

Background: Breast carcinoma is near (32%) of all and the second cause of malignacies related deaths in woman and one of the main investigated subjects for prognostic and predictive factors. One of these factors is Human Epidermal Growth Factor Receptor-2 (HER-2), if found in normal stroma could be predisposing to carcinoma.Study Design: We decided to evaluate the prevalence of HER-2 in benign tissue around breast tumors and gathered 106 among 2167 breast carcinoma cases in Cancer Institute since 2002-2004. A retrospective descriptive analysis was conducted and besides the main subject, correlation between the age and pathologic type was considered.Finding: We found 58% HER-2 positive in the tumor of our cases and 39% of them had also positive HRE-2 in their normal breast tissue around tumor compared with 32% negative HER-2 in tumor with 12% negative normal breast tissue. More than half (%66.4) of the cases had 41-60 years old in most common type of malignancy was invasive ductal.Conclusion: Positive HER-2 in normal breast tissue could be predisposing (risk ?) factor for malignancy.

Introduction & Objective: Morbid obesity is one of the most important problems of nations. This problem is defined as increasing of BMI (Body Mass Index) over 35- 40 kg/m2. Morbid obesity is the cause of social and economical problems and involves lung, heart, joints, causes diabetes mellitus and psychological disorders it may causes venous thrombosis. Then treatment of this problem is a necessity. Some methods for treatment of this disorder mentioned as dietary or medical regimens but these two methods waste a lot of time and are reversible and it could not be tolerated by patients. Our aim in this survey was assessment of efficacy of the gastric banding operation in weight loss of patients with morbid obesity and post operative satisfaction of patients. Material & Methods: In this survey, 57 women which undergone gastric banding operation with Mersalin mesh were assessed from autumn 1999 to autumn 2003. Pre-operation and 3 months after operation, weight of them were evaluated and documented. Then data were analyzed by SPSS software.Results: Analyzing of data showed that mean weight of patients before gastric banding operation with Mersalin mesh (103.88 kg) to mean weight of them after operation (91.14kg) had significant statistically difference (P value < 0.01). In this study, there were no mortality and morbidity, no complications in patients after surgery. Almost of all patients (except 2 cases) were satisfied from horizontal gastric banding operation.Conclusions: On the basis of our results weight loss in gastric banding operation in morbid obesity is significant on the other hand this weight loss is persistent. This operation is recommended as a helpful and valuable method in treatment of morbid obesity. It could also be mentioned as cost effective method.

Introduction & Objective: Rotation is a term implicating the normal programmed return process of bowel from physiologic hernia to abdominal cavity. 55% of this happens in the first week of life and 80% of this in the first month of life.Material & Methods: This cross-sectional study has been done on the all patients with the diagnosis of malrotation at Mofid hospital from 1981 till 2003.Results: There were 113 patients (76 males, 37 females). 50 patients (45%) were under one monthage, 36 patients (31%) were one month age to 12 months age and 27 patients (24%) were older than one year old. The mean of infant's age was 2.7:t. 1.2 years (minimum 1 day of age and maximum 9 years old). All the signs and symptoms of their disease and radiological studies of them have been studied in our study.Discussion: As in other studies, the ratio of males to females in our study was 2/1. All the patients under one year old came with acute or chronic bowel obstruction symptoms, whereas the older ones came with different (presentations?) manifestations, confirmed with the other studies, the main reason of this diversity are the anatomy and physiologic condition of children of this age (over one year old)?Conclusions: At the end, a prospective research to study the clinical manifestations and radiological studies of bowel melioration seem to be needed.

We introduce a patient that had an esophageal rupture after a cold drink. This patient had not any problem before last drinking. After a cold drink, a sudden sever retrosternal and right hemithoracic pain was started.Initially, with inspect to dyspnea and right chest pain, pleural effusion and empyema was diagnosed and a right side tube thoracostomy was done (right side chest tube). After regular diet starting, food materials were seen at her chest tube.Because of high rate of cold drink consumption -especially at summer- physicians must be aware of this significant and harmful complications.

Introduction & Objective: The sigmoid colon is the most frequent site for volvulus. In Iran sigmoid colon volvulus is the most common causes of colon obstruction. In this report, we compare the size of sigmoid in patients with sigmoid colon volvulus and normal population.Material & Methods: The size of sigmoid colon and the mesosigmoid were measured in 25 patients with sigmoid colon volvulus and in 50 patients without volvulus.Results: The length of sigmoid colon in patients were larger (mean: 72 cm) than normal sigmoid (mean :37cm) and measure of mesosigmoid was larger (mean: 28cm) than normal (mean: 14 cm).Conclusions: The subclinical features (abdominal pain and constipation), plus redundant sigmoid colon on barium enema are diagnostic, and prophylactic surgery is justified to avoid the mortality and morbidity associated with established cases of sigmoid volvulus.