Iranian Journal of Surgery
Year:2012 | Volume:20 | Issue:3|Papers Count:10

Introduction & Objective: Fractures of the lateral humeral condyle are the most frequent elbow fracture in children after supracondylar features and in cases of displacements, open reduction and internal fixation is the standard treatment in displaced fractures. The purpose of this study was to evaluate the results of the surgical treatment of lateral humeral condyle fracture in children in our institute.Materials & Methods: In this cross-sectional study, 26 patients, between 2-14 years old, who had lateral humeral condyle fracture and were operatively treated during April 2004 to May 2007, were enrolled. Demographic data, fracture type, surgical technique, time interval between trauma and surgery and presence of any complication were collected. At the final follow up, patients were evaluated for elbow range of motion, limb alignment and deformity. Radiographs were evaluated for the quality of union and any deformity. Chi2 and fisher tests were used for statistical analysis.Results: All of the reviewed cases suffered from Milch type II fracture. Surgical treatment in 46% was performed within 24 hours and in 54% after 24 hours. There was no significant relationship between the time of surgery and outcomes and complications (P=0.085). Limited range of motion and deformity was present in 15.4% and 7.7% of cases respectively. There was no mal-union or nonunion. Lateral spur formation was found in 11.5% of patients in the last radiograph.Conclusions: Open reduction and internal fixation is a safe and effective treatment method for lateral humeral condyle fracture with displacement and true anatomic reduction and fixation is the most important factor in the treatment outcome. Time interval between truma and surgery had no correlation with clinical results and complications.

Introduction & Objective: The inguinal hernia is a common disorder in general surgery. Various methods have been described in hernia repair. In modern methods, synthetic mesh is used to cover the defect and the most known method is Lichtenstein surgical repair, the present study was done to assess the effectiveness of antibiotic prophylaxis for tension-free mesh hernioplasty.Materials & Methods: In a double blind controlled clinical trial, 200 patients with unilateral inguinal hernia were randomly assigned to either intravenous placebo or antibiotic prophylaxis. A questionnaire containing age, sex, type of anesthesia, duration of surgery and the condition of the wound was filled up for each patient in the study. Data in questionnaire and forms were analyzed with SPSS software version 17 and descriptive statistics and if needed for the evaluation of significance, statistical T-test and chi- square test and even accurate test of Fisher were used.Results: In present study, the mean age of studied persons was 55.49 years with a standard deviation of 12.14 years (the minimum age of participants was 17 year and the maximum was 87 years). Of these patient’s, 184 persons (equal to 92%) were male and others were female. The number of wound infections was 3 (3%) in the antibiotic prophylaxis group and 6 (6%) in the placebo group (P=0.249).Conclusions: These results showed that the differences between the two groups are not statistically significant. Therefore, the routine use of antibiotic prophylaxis for tension-free mesh hernioplasty, may not be necessary. For a definitive statement, study with a larger sample size would be necessary.

ntroduction & Objective: Breast cancer is a fatal disease that causes morbidity and mortality in women worldwide. Assessment tools for the risk of breast cancer are widely used for counseling and determining eligibility for breast cancer. The usefulness of these tools in the case of Iranian women is uncertain. So we decided to use Gail model for predicting absolute risk of invasive breast cancer in women who refer to health centers of Yasuj, Iran.Materials & Methods: In a cross sectional study, we used data from 513 women who were referred for routine woman health programs in Yasuj health centers, during 2010-2011. Age, marriage status, age of marriage, pregnancy and menopausal history and Gail Model results for these people was determined. T-test and Anova were used in the evaluation of the averages and SPSS 15 software was used for the analysis.Results: The mean of age of this group was 41.8+6.1 years. The risk of breast cancer in the next five years (5R) was 0.55% and the risk of breast cancer during the whole life (LTR) was found to be 8.2%.14 women (2.7%; CI 95%: 1.1-8.5) had high risk of breast cancer, based on Gail Method. Mamography and sonography were normal in these women.Conclusions: Based on Gail model, the risk of breast cancer in these women was determined to be 2.7%. More studies for the rest of the population are necessary for a final judgment.

Introduction & Objective: Pleural malignancies are the third etiology of malignant pleural effusion. About 50% of the patients with metastatic cancers develop this condition. The presence of malignant pleural effusion in such patients often implies a low survival rate and poor therapeutic outcome. This study was aimed to evaluate the frequency of recurrence after Talc powder instill through chest tube into the pleural cavity, among patients with malignant pleural effusion who referred to Besat Hospital in Hamadan, Iran.Materials & Methods: In this prospective observational study, 90 patients with malignant pleural effusion who were admitted to the surgery and hematology-oncology departments of Besat Hospital in Hamadan, during 2010 and 2011 were evaluated. All enrolled patients had confirmed documents of malignant pleural effusion, using radiologic, clinical, and laboratory techniques, including cytological and chemical analysis of pleural fluid. Pleurodesis was performed for all patients by instilling 5 mg of asbestos-free talc powder through a 24F chest tube. After the application of pleurodesis procedure, patients were followed up monthly regarding the treatment response, complications, and recurrence for three months, and the serial radiologic images were compared to the previous ones. The data in the questionnaire and forms were analyzed with SPSS software, version 17, and descriptive statistics.Results: In this study a total of 90 patients were involved the mean age of patients was 58.86±12.00 years and 64.4% (n=58) were male. The most common symptom was cough (92.2%), followed by chest pain (81.87%), dyspnea (57.8%), and weight loss (17.8%). The average duration of keeping chest tube was 3.72 days and the average hospital stay was 5.74 days. Lung cancer (n=24, 26.7%) was the most common underlying malignancy. Seventy-nine (87.8%) patients showed successful treatment, while 11 (12.2%) had recurrence. After 3 months of follow-up, cough, chest pain, and dyspnea were reported in 11.1%, 6.7%, and 3.3% of the patients respectively. Fifty-two (57.8%) patients had no significant complications. The most common reported complication was post surgical fever (20%), followed by chest pain (17.8%).Conclusions: The results of this study suggested that Talc powder administration through chest tube is a suitable treatment for the malignant pleural effusion, with low rates of recurrence after 3 months of follow up. However, it is recommended to perform similar investigations, using thoracoscopy to provide comparative information. Also conducting a controlled clinical trial, using other sclerosant materials, is suggested.

Introduction & Objective: Placenta previa is one of the main causes of vaginal bleeding at the late phase of pregnancy. Many studies report that Placenta previa causes low weight at the birth (LBW) and intrauterine growth restriction (IUGR). Therefore, it increases neonatal mortality rate. This study was performed to estimate the relative frequency of placenta previa and its association with LBW and preterm delivery at Rashtal-Zahra hospital during 5 years.Materials & Methods: This is a descriptive study and was conducted at this hospital by using of patients files of those who had delivery in hospital from 2001-2006. Placenta previa was diagnosed before delivery. The collected data included neonatal weight, maternal age, gestational age, parity, history of previous cesarean and abortion, IUGR and preterm delivery.Results: Of the total 32866 delivery, 79 cases of Placenta previa were observed, of which 29.1% hadLBW.79.1% of mothers were between 20-34 years old.45% had parity one, 12.7% had a previous cesarean and 22.8% had abortion. The relative frequency of preterm delivery was 40.5% and 8.9% had IUGR. The most frequent case of Placenta previa was found in 30-34 years old group.Conclusions: In this study, the relative frequency of LBW and preterm delivery in placenta previa were more than other studies.

Introduction & Objective: Patients with stoma are confronted with many physical, psychological and social problems. These problems cause disruption in natural processes of life and its quality. However, in our country, attention has not been paid to the concept of quality of life in patients with stoma. So the aim of this study was assessment the quality of life of patients with intestinal stoma and the related factors.Materials & Methods: This research is a cross-sectional study. Eighty four patients with ostomy, who referred to selected educational centers of Tehran University of Medical Sciences and Iranian Ostomy Association (IOA), were selected through a convenient sampling method. The data were collected using City of Hope Quality of Life-Ostomy Questionnaire and were analyzed by SPSS 15, using descriptive statistics, independent t-test, ANOVA and regression analysis.Results: In this study, most patients scored 7 and above for overall quality of life and each of its dimensions. The highest and lowest scores of the quality of life, were associated with physical dimensions (7±1.5) and social dimensions (6±2), respectively. Moreover, the quality of life had a significant relationship with age (P<0.01), financial status (P<0.01), stoma status (P<0.05) and stoma duration (P<0.05).Conclusions: Based on the results of this study; age, financial status, stoma status and stoma duration are related with quality of life in patients with intestinal ostoma. These findings could be helpful for the nursing activities to improve health and quality of life of these patients.

Intestinal cutaneous fistulas are a challenging matter in abdominal surgery. Different treatment modalities have been suggested. This is a report of two times injection of 10cc meglumine 300, containing Gelfoam particles, in duodeno-cutaneous fistula, which led to good results. Gelfoam may be useful for the management of high output GI fistula.