Iranian Journal of Surgery
Year:2009 | Volume:17 | Issue:2|Papers Count:18

Introduction & Objective: In this manuscript, it is not intended to discuss the real indications or different techniques in the management of lumbar disc disease, but it is intended to put forward the question; “Is disc degeneration a disease?”. Accordingly, it will be tried to review the literature in a narrative manner and give way to the readers to design better studies for finding the real answer.Materials & Methods: A Medline search was done by following the key words: Black disc, Lumbar Disc herniation, Low back pain. The criteria for inclusion were relevance to the topic, randomized clinical trial, natural course or cohort study.Results: 8 randomized trials, one cohort and one natural course studies were selected. Conclusions: As we shall see, the present studies have not found a suitable answer to this question. Furthermore, weak and divertive studies are not rare in this case.

Introduction & Objective: Ischemia and necrosis of flaps is a challenging problem in reconstructive surgery. There are numerous articles dealing with the effects of pharmacological agents in halting or reversing these processes. In this study, the effects of aspirin, dexamethasone and their combination on skin random flap survival in rats were examined.Materials & Methods: Forty male Sprague - Dawley rats were randomly assigned to four equal groups. Group 1 (control), group 2 (aspirin), group 3 (dexamethasone) and group 4 (aspirin + dexamethasone). The first group underwent a rectangular 3×11 cm modified distally based Macfarlane type flap surgery under anesthesia then the flap sutured back into its primary site over a sterile surgical drape. The 2nd group aspirin 100mg/kg was given to rats one hour before the flap surgery. In the 3rd group after the flap surgery dexamethasone 2.5 mg/kg was divided in three equal doses was injected locally to the distal of the flap and continued daily for another 2 days. In 4th group we combined the methods used in groups 2 and 3 (each rats received both aspirin and dexamethasone). After seven days all the rats were anesthetized and after digital photography the areas of flaps survival were compared and analyzed with statistical methods.Results: The areas of flap survival in control group were 44±6.5 % (mean±SD), in Aspirin group were 53±7.5%, in dexamethasone group were 57.8±8.5 % and in Aspirin + dexamethasone group were 60±8%. Only Dexamethasone group and Aspirin + dexamethasone group showed significantly improved flap survival relative to control group, but the effect of Aspirin alone was not statistically significant (P<0.05).Conclusions: The effect of dexamethasone on random flap survival of Rat was significant, but aspirin alone had no significant result.

Introduction & Objective: Management of post intubation tracheal stenosis in patients with cardiac problems hasn't been considered as a separate item. In this study, we tried to investigate this problem and to find the potential differences in this group.Materials & Methods: In a retrospective study of patients with post intubation tracheal stenosis, treated between 1994-2008 at Masih Daneshvari Hospital, results were compared between two groups, study group (a group of cardiac patients with primary heart diseases or history of cardiac surgeries), and all other patients (control group).Results: Patients in the study group had a higher mean age than the control group, but the results of treatment were similar in both groups. However, the response to the non surgical methods was better in the study group.Conclusions: The presence of cardiac problems in the patients with post intubation tracheal stenosis shouldn't affect our decisions for the treatment of these patients. Tracheal resection and anastomosis isn't considered a highly stressful operation in these patients.

Introduction & Objective: Plantar fasciitis is the most common cause of heel pain. Because the cause of this pain is uncertain, there are many treatment methods for it. Our study compares the results of two most common treatments known as steroid injection and plantar fasciitis stretching with each other regard to decrease in pain and improving function.Materials & Methods: 66 patients with heel pain and clinical diagnosis of plantar fasciitis, and for whom other causes of heel pain had been ruled out were studied. They were randomly categorized in two groups. One group was treated with local corticosteroid injection and the other group with plantar fascia stretching exercises. After 2 and 8 weeks, they were evaluated regard to function and pain scores.Results: There is no difference between two groups regard to sex, age, height, weight and body mass index. There was significant decrease in pain and improvement in the function of the group which had corticosteroid injection, but, in the 8th week, the two groups had the same results in both aspects.Conclusions: This study show that after 8 weeks of treatment with both therapeutic methods, the results were the same, therefore, it is better to use the less complicated and less expensive method (i.e. stretching), but in cases which prompt pain relief and better function is desired, corticosteroid steroid injection may be better.

Introduction & Objective: Outcomes of Deep Vein Thrombosis (DVT) is related to the anatomical location of thrombosed venous segments. The aim of DVT treatment is prevention from extension of thrombosis, recurrence of DVT, Pulmonary Emblolism, and Short term and long term sequela. In this study we compare the long term outcomes of systemic anticoagulation therapy in patients with iliofemoral and femoropopliteal vein thrombosis.Materials & Methods: All patients with iliofemoral or femoropopliteal vein thrombosis that treated by standard antithrombotic therapy between 2000-2003 were selected. Patients at 5 year follow up were reexamined. Vavular reflux and venous re canalization were studied with dupler sonography and analyzed by chi- squared test.Results: Patients with iliofemoral or femoropopliteal vein thrombosis were 52 and 85, respectively. Valvular reflux in patients with iliofemoral or femoropopliteal vein thrombosis was %81 and %61, respectively. The patency rate was %21 in iliofemoral DVT and %40 in femoropopliteal DVT. The rate of Post Thrombotic Syndrome was %40.5 and %21 in iliofemoral and femoropopliteal vein thrombosis, respectively.Conclusions: Because of higher rate and severity of morbidity in iliofemoral DVT patients, they need an aggressive approach in treatment such as catheter directed thrombolysis or surgical throbectomy for facilitated clot removal, preservation of functional valve and venous patency.

Introduction & Objective: Acute appendicitis is one of the most common surgical emergencies. The main step in the diagnosis of appendicitis is: accurate history, clinical evaluation and physical examination. Because to increase of C-Reactive protein in inflammation states, and the fact that the decrease of negative appendectomy can lead to the decrease of morbidity and mortality and hospital's costs, the diagnostic value of high - sensitive CRP, in the care of acute appendicitis has been evaluated in this study.Materials & Methods: In a descriptive - analytic study, blood for the measurement of serum c-reactive protein was collected, pre - operatively, from 84 patients, who had appendectomies at the Shahid Beheshti hospital .The histopathology was grouped into positive (acute appendicitis) and negative (normal appendix) and this was correlated with the CRP values, that were measured with ELISA. Receiver operating curve was constructed for CRP and the best cut off point was used to calculate sensitivity and specificity of the test.Results: In 84 patients, 61/8% were males and 38.1% were females, the male to female ratio being 1.6: 1. On histological examination, 86.9% had acute appendicitis whereas 13.1% had normal appendictis. The cut off value of high sensitive -CRP was 31.48 g/ml (P=0.049). The area under curve (AUC) was 0.699. The sensitivity and specificity of CRP was 90% and 20% respectively.Conclusions: High sensitive CRP can be used to support the clinical diagnosis of appendicitis, thus unnecessary removal of normal appendix may be reduced.

Introduction & Objective: Arterio - Ventricular fistula (AVF) is the choice route for hemodialysis. The complications arising from arterio -ventricular fistula include fistula aneurismal changes and steal syndrome. In this article we introduce 2 new methods for controling the complications in the side to side fistula of upper extremities.Materials & Methods: This case series study we ligated the vein at both proximal and distal ends in patients with aneurismal changes. Then the aneurismal vein was cut and released at both ends, and using point pressure the aneurismal contents was emptied, and after repair compression bandage was performed for a week. In another method, patients suffering from steal syndrome, with elbow side to side AVF were evaluated by upper extremity Doppler sonography and the upper extremity perforan vein were ligated.Results: In aneurismal changes after a week from compression bandage, fibrosis formation in the site, aneurism was eliminated and no complication was found in the follow up. In the case of Steal syndrome, an increase in the blood pressure was noticed in perform vein and by closing this vein we could control the steal phenomenon. Signs disappeared in all the patients and AVFs were saved in 80% of the cases.Conclusions: Our findings shows that in treating patients suffering from steal syndrome in perforating side to side fistula, vein closure is useful. Furthermore, cutting the perforating vein can stop the expansion of the syndrome. In patients suffering from aneurismal changes, no complications were seen in the follow up.

Introduction & Objective: Breast reduction is performed frequently, and many different surgical methods have been described. The goal of the procedures is to obtain an aesthetic and long-standing result with a safe technique and limited scarring. Breast sensation after reduction mammaplasty is a major concern for surgeons and patients. A prospective study was designed to measure the recovery of breast sensitivity after this operation.Materials & Methods: The sensitivity of 82 breasts in 41 patients was assessed in a prospective study in Hazrat Fatemeh Hospital. Five points were selected on each breast for this study including the nipple-areola complex (NAC) and each quadrants of the breast. The measurements were performed preoperatively and 6 months after each operation. Tests involved Semmes-Weinstein monofilaments, which deals with static and moving two point discrimination, were before the operation and six months after it.Results: One patient was eliminated of our study according to post operative side effects. The Medial pedicle was used for 14 patients. A superior pedicle was used for 15 patients. An inferior pedicle was used for 11 patients. The moving two-point discrimination showed the greatest change postoperatively. Sensation of the nipple-areola complex (NAC) was decreased 6 months after the operation in all techniques and the differences were significant (P<0.05). Sensation of the upper quadrants were decreased in medial pedicle technique and sensation of the lower quadrants in superior pedicle technique in comparison with preoperative results (P<0.05). Sensation of the medial quadrants were increased and lateral quadrants were decreased in inferior pedicle techniques (P<0.05). There were no significant differences between the three techniques in preservation of NAC sensation.Conclusions: Moving two-point discrimination is the best test for evaluation of the breast sensation. When comparing superior, medial and inferior pedicle in patients undergoing reduction mammaplasty, there were no significant differences in postoperative sensory outcome and sensation is not an important factor in technique selection. However, the decrease of NAC sensation must be discussed with patient before under taking reduction mammaplasty.

Introduction & Objective: Submucosal hemorrhoidectomy is one the accepted techniques of surgery but it has never been a popular operation. The advantage of this surgical method is that it minimizes the injury to anoderm and mucosa of anus. The aim of this study was to compare between submucosal hemorrhoidectomy and Ferguson hemorrhoidectomy.Materials & Methods: In a clinical double-blind controlled trial, 60 patients with grade 3 and 4 hemorrhoids were randomly divided into two groups: 1) submucosal hemorrhoidectomy (30 patients) and 2) Ferguson hemorrhoidectomy (30 patients). These patients were evaluated for early and delayed post operative complications such as pain, bleeding, urinary retention, constipation, fecal impaction, incontinency, surgical site infection, fissure, skin tag, mucosal ectropion, anal stenosis and recurrence. They were regularly followed up at 24 hours, 1 week, 3 months and 6 months after their operation.Results: There were no statistically significant differences between two these groups in terms of age, gender and grade of hemorrhoid(s). Patients treated with submucosal hemorrhoidectomy has significantly less pain within 24 hours after the surgery (P=0.026), but there was no statistically differences between two groups in anal stenosis and other complications.Conclusions: Submucosal hemorrhoidectomy is an effective method in reducing post operative pain within the 24 hours after the surgery and was no case of complicated anal stenosis after 6 months follow up. Other complications in the submucosal technique were similar to those of Ferguson. Submucosal hemorrhoidectomy is comparable with Ferguson technique as a suitable procedure for high grade prolapsed hemorrhoids.

Introduction & Objective: In previous studies it had been shown that administration of prophylactic oral calcium in patients who undergoing total and subtotal thyroidectomy, decreases postoperative hypocalcemia symptoms and the duration of hospital stay. The aim of this study was to assess the effects of prophylactic oral calcium administration in patients undergoing total or subtotal thyroidectomy.Materials & Methods: In a randomized clinical trial, 43 patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to 2 groups the case (n=23) and the control group (n=20). Oral calcium carbonate (1 gr q 8 hours) was given to the patients in the case group since 12 hours before surgery to 7 days after surgery. Patients' demographic characteristics, duration of hospitalization, symptoms and signs of hypocalcemia, levels of calcium, and use of intravenous administration of calcium were compared.Results: The mean postoperative calcium levels 12 and 24 hours after the operation were significantly lower in the control group (P=0.049, P=0.021 respectively). The number of patients who had paresthesia after 12 and 24 hours after operation was significantly higher in the control group than the case group. Duration of hospitalization was significantly lower in the case group compared to the control group (P-Value = 0.006).Conclusions: Prophylactic oral calcium supplementation decreases the paresthesia after 12 to 24 hours after operation and need to infusion of intravenous calcium administration. It also decreases the duration of hospitalization.

The dislocation of the thumb carpometacarpal (CMC) joint is a rare injury, and dislocation is even more uncommon. Delay in diagnosis and treatment of this type of dislocation usually will be accompanied with unfavorable result there with pain and decline of contraction force of thumb, and even it might be accompanied with erosive arthritis. Therefore, the dislocation of the thumb CMC must be diagnosed quickly and have a suitable remedy for its coming back to normal function of injured hand.In this case-report, we surveyed a case of traumatic dislocation of the carpometacarpal joint of the thumb in seventeen-years-old male. The patient had carpometacarpal dislocation of the thumb of right hand that in due to a motorcycle accident, and had pain in the physical exam and had tenderness in thumb CMC therewith somewhat deformity and swelling. After surgery the thumb was immobilized for six weeks and after which he was enrolled into a rehabilitation program. There was no pain, joint instability and restriction range of motion at the end of six months.

There are few reported cases of cutaneous metastases of esophageal carcinoma, especially of esophageal adenocarcinoma. We present a case of a 71-year-old man with metastatic esophageal cancer in the scalp. Clinical and histological findings are discussed, and recommendations for clinicians are suggested.

There is an increasing trend in the world population toward doing nose surgery. Aesthetic surgery of the nose is one of the most popular ones, especially in this part of the world. The outcome of this sophisticated operation is directly related to the skill and knowledge of the surgeon and his good understanding of aesthetics and psychology. Iranian surgeons have developed great success in this field and their ideas are spreading in the world. Looking at Google search engine under “nose surgery”, you find out that several famous international press agencies refer to Iran as the world capital of nose surgery. This operation was introduced in this country about 50 years ago and since then more surgeons and patients became interested in doing this procedure. This trend persuaded us to write a background and current overview for colleagues who are interested in this subject.