Iranian Journal of Surgery
Year:2017 | Volume:25 | Issue:3|Papers Count:12

Introduction & Objective: The main purpose of this review is to discuss the latest recommendations and strategies for treatment of pediatric patients with traumatic brain injury (TBI).Materials & Methods: Through this review, 45 eligible and relevant studies were chosen and the level of evidence was evaluated. The statements which are discussed as “recommendations” refer to class II level of evidence, while the ones which are brought as “options” refer to class III.Results: In pediatric patients with TBI, CPP should be kept above 40mmHg. Bolus infusion of mannitol (0.25- 1g/kg) or continuous infusion of hypertonic (3%) saline (0.1-1 ml/kg) are useful methods to reduce ICP. It is recommended to use minimum doses to decrease ICP to 20mmHg. Administration of steroids suppress endogen cortisol secretion and increase complications like infection. Long-term prophylactic hyperventilation, even mild, should be avoided.Conclusions: Undoubtedly, nothing is more effective than proper prophylaxis. The main duty of a physician in confronting TBI is to reduce secondary injuries caused by hypoxia, hypotension, elevated ICP, reduced CPP, cerebral ischemia, etc.

Introduction & Objective: There is rising variety of fillers used in aesthetic surgery for skin augmentation and enhancement. The natural fillers include free fat graft, derom-fat graft and reverse dermo-fat graft (dermis down and fat up). There is not a unified opinion on comparative longevity for these grafts among authors. The purpose of this article is to find out the out the come of these grafts in the animal model.Materials & Methods: The study was performed at St. Fatima hospital animal laboratory on 12 Spraugue Dawly male rats who weighed 300 to 350 grams. Three forms of auto fat graft including free fat, dermo-fat and reverse dermo-fat was applied and after two months animals were sacrificed. The specimens were weighed before and after grafting with precise digital scale. All specimens stained with H& E dye and studied for the amount of fibroblast proliferation, collagen bundles, necrosis, neovascularization and eosinophil and giant cell infiltration.Results: We found statistically no significant difference of the pre and post graft weight changes between these three groups. We also couldn’t find and significant differences between the amount of fibroblast proliferation, collagen bundles, necrosis, neovascularization and eosinophil and giant cell infiltration.Conclusions: These findings show that free fat can be used as filler with no need to be combined with dermis. On the other hand we found out that derom-fat take and outcome is not dependent on the position of dermis whether to be over or under the fat graft.

Introduction & Objective: Professionalism is defined as behaviors, goals, or qualities that characterize a profession or a professional person. Teaching professionalism is an essential part of medical residency training. This study aimed to evaluate the level of professionalism and its associated factors in residents in Iran University of Medical Sciences.Materials & Methods: This cross-sectional study included 117 residents from Iran University of Medical Sciences in 2016. The main outcome was professionalism score measured by the Persian validated version of the American Board of Internal Medicine (ABIM) questionnaire. Sex, study field, education grade, and to be familiar with professionalism concept were registered. T-test, ANOVA, and multiple linear regression were used for data analysis.Results: Mean±SD age of the 103 residents was 30.17 ± 2.22 years. The mean ± SD of professionalism and its subscales were 6.1 ± 0.63, 6.35 ± 1.05 for honor/integrity, 6.03 ± 0.9 for altruism/respect, and 5.58 ± 1.38 for excellence, respectively. The results showed that study field (gynecology and neurology) was associated with professionalism (P<0.05). In addition, it was revealed that being male was a significant factor of higher score of honor/integrity (P=0.049). Moreover, familiarity with professionalism concept (P<0.001) and study field (surgery, pediatric, and ear, nose and throat) were associated factors with higher score of excellence. None of the factors had a significant effect on altruism/respect (P>0.05). Residents’ age was correlated to none of the scale/subscales (P>0.05).Conclusions: Based on the findings, it could be concluded that to assign professionalism course seems necessary in residency program to enhance the professionalism level in studied population. This study can be an introduction to future researches to distinguish the associated factors with professionalism among different fields.

Introduction & Objective: Autoimmune cytopenic purpura (ITP) is a kind of disease accompanied with thrombocytopenia and platelet damage. The first line treatment is corticosteroid therapy, but always it's not effective. The aim of this study is find out the therapeutic value of splenctomy in these patients’s who that refers to speciality Immam Reza hospital between 2005-2015.Materials & Methods: In this study 88 patients with ITP who had undergone surgery for splenectomy were evaluated. We used a retrospective and clinical review method. The related data of gender, clinical signs, history of blood transfusion and treatment before splenectomy and patient condition after splenectomy are extracted and analyzed after codifying in SPSS 21 software and descriptive statistic.Results: The average age of the patients and those who had done splenectomzed were 39 years. The ratio of man to woman was equal. The results show that there is meaningful relationship between response to splenectomy and low age (P=0.002) and also there is a meaningful relationship between using IVIG before splenectomy and rise platelet number after splenectomy (P=0.004).Conclusions: Splenectomy, specialty using IVIG before that is good treatment for ITP.

Introduction & Objective: One of the efficient and available ways to treat the hyperhidrosis is thoracic sympathectomy. Our goal of this study was to evaluate the success rate of this method of therapy in patients with hyperhidrosis.Materials & Methods: This cross-sectional study enrolled all patients with initial hyperhidrosis in Babol Medical Sciences hospitals, between the years 2003-2015 whom have been hospitalized and treated by surgery. Eventually the patient entered the study were 51. The data analyzed by SPSS V.20 and using statistical test of Chi-Square, T-Test analysis.Results: Of the 51 patients, 47 patients (92.1%) had no complications after surgery, 44 patients (86.2%) had complete response after surgery. There was no significant relation between age and success rate (P=0.22). Between age of onset and thoracoscopic sympathectomy success rate there was no significant correlations (P=0.54). There was no significant relation between job of patients and the success rate (P=0.34). The findings indicate that the final result of sympathectomy surgery is in close relation with the level of sympathectomy (P=0.01).Conclusions: Sympathectomy is a safe and effective treatment for patients with hyperhidrosis.

Introduction & Objective: Reconstruction of the ear is one of the major challenges in plastic and reconstructive surgery. Loss of all or part of the ear causes mood disorders, depression, and loss of self-confidence, anxiety and disturbance in patient's social interactions. Therefore, a study was conducted to determine the Statistical assessment of ear repair in terms of lesion size in patients referring to Center for Plastic Surgery 15 Khordad from July 2010 to December 2013.Materials & Methods: This study is a descriptive cross-sectional study. The samples consisted of 126 patients referring to Center for Plastic Surgery 15 Khordad (from July 2010 to January 2013). A special surgical technique was used in each patient regarding the type of injury and ear lesion. Patients after the surgery were followed up to evaluate the effectiveness of the surgical technique. Finally, the data were analyzed using SPSS V.22.Results: In this study, the greatest cause of ear trauma was accidents with vehicles (39.5% in men, 42.8% in women and 75% in children). Also, the acceptance and satisfaction of patients in ears reimplantation method was significantly higher.Conclusions: The use of ear replantation method has more advantages compared to other reconstructive methods. Also, the satisfaction and acceptance of patients in the replantation method is much more than other recent techniques.

Introduction & Objective: The main purpose of this study was investigating the effectiveness of emotionally focused group therapy on marital satisfaction and quality of life in the women undertake mastectomy.Materials & Methods: The study population included 30 women who undertake mastectomy and attending the Cancer Care Center in Shiraz city. They were selected with accessible sampling method and randomly divided to experimental and control groups. The participants completed Marital Satisfaction Scale and Quality of Life Scale before and after intervention and also one month after the end of intervention. Control group do not receive any intervention.Results: The results showed no significant differences between the pre-test scores of both groups.However, in Post-test, the score of the experimental group in marital satisfaction (11.115 ± 56.87) and quality of life (9.79 ± 84.75) is significantly different from score of control group in marital satisfaction (9.90 ± 08.87) and quality of life (9.79 ± 84.75). The data were analyzed by using ANOVA test and SPSS 22 software.Conclusions: The results determine that variables of the study are significantly (P<0.001) increased in the experimental group in compared with the control group.

Introduction & Objective: Pain relief during labor is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy and interferes with the mother's family relationship. The aim of this study was to evaluate the comparison between Entonox and controlled breathing technique during labor for pain management in labor.Materials & Methods: This double-blind semi-experimental was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Valiasr Broujen, Iran. Before entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n= 35) or controlled breathing technique (n=35) as a control group. Mothers inhaled the gas or breathing at the commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate's birth. Main outcomes were pain score based on VAS (visual analog scale), duration of delivery. Chi-square and Independent T-test were used for data analysis and P-value less than 0.05 was considered statistically significant.Results: Seventy pregnant women with a mean age of 25.25 ± 4.66 years were studied. Mean of pain severity score during labor in the Entonox and controlled breathing technique groups was not significantly changed (P<0.05). However in each group main of pain severity was significantly decreased (P<0.001).Conclusions: Using Entonox or controlled breathing technique are effect for reducing labor pain and there are cost benefits without the significant increase in maternal and neonatal complications for controlling pain severity during of labor.

Hydatid disease is endemic in the Middle East, including Iran and is one of the common diseases between humans and animals. Unlike adults, the most common site of involvement is the lung disease in children. Currently remove the cyst through surgery, a choice approved for the treatment of pulmonary hydatidose. Choice of surgical technique depends on the location and size of the hydatid cyst. The aim of this study is to report a case of Single-stage surgical lung and liver hydatid cyst in a 2.5 years-old child, which been followed to the successful outcome.

This report presents a case of 28 years old woman suffering from pemphigus vulgaris, who is candidate for emergence cesarean section due to fetal distress. The complications, which an anesthesiologist might face them during management of these cases, are highlighted here. Additional care to protect skin and mucus membranes against trauma and also adrenocortical suppression because of prolonged steroid therapy must be considered.

Ginger is a plant widely used in complementary medicine because of its various therapeutic properties.In recent medical and compelimentary medicine textbooks, it has been stated that the oral form of ginger is antiemetic, prevents vomiting and motion sickness, is used as an analgesic and anti-inflammatory, and enhances the memory. If the patients had used specific amounts of ginger or its products routinely before surgery and anesthesia, it could have consequences such as increased bleeding and analgesic effects during surgery and anesthesia. In this Study, we assessed the side effects and warnings surgeons and anesthesiologists had stated as interactions of this plant considering reputed Iranian’s traditional and new medicine and papers that texts published in the different Database.