Iranian Journal of Surgery
Year:2016 | Volume:24 | Issue:1|Papers Count:17

Chronic pain after inguinal herniorrhaphy has been known for many years; and it was thought to be due to musculoskeletal and pelvic problems. And if persistent and annoying the possibility of neuroma or nerve entrapment would be raised, but the surgeons were not enthusiastic to do anything for it other than conservative or palliative treatment. In the past two decades with wide spread use of mesh, this complication has increased to an extent that has drawn attention and research towards it. So the aim of this article is to discuss, its pathogenesis and prevention along with current treatment trends for this syndrome.

Introduction & Objective: Epidermplysis bullosa (EB) is a genetic disease with skin fragility and instability at the junction of dermis to epidermis. Severe deformity of hands because of scars and adhesions leads to lose the proper function of hand which affects the quality of patients’ life. Covering the wound after opening adhesion is the major problem in the way of reconstructive surgeons. Our purpose in this study is to use allogeneic fibroblasts amnion after surgery as a cover in patients to prevent further adhesion.Materials & Methods: This study was an experimental study that was done on six Epidermplysis bullosa Patients with hand deformity and Adhesion. We took a skin sample from back of one of parents’ear. Then fibroblast was separated, cultured and transferred to the amniotic membrane. After separating the full adhesion, all parts without skin were covered with the allogeneic fibroblast amnion. Furthermore, speed, quality, recovery time of wound were examined as well as range of motion in finger joints and the pressure on skin.Results: The results of the study showed that wound healing well done and for wound healing varies between 15 to 29 days and the average length of treatment was 1.23 days with a standard deviation 77.3.Skin repair and rehabilitation activities as well as the pressure of splint has endured.Conclusions: Allogeneic fibroblast with a scaffold like amnion can reduce the need for skin graft in patients with Epidermolysis Bullosa. Normal allogeneic fibroblast and disability of releasing collagen seven in these patients can be effective factors in wound healing and be better than autogenic fibroblasts.

Introduction & Objective: There is a large spectrum of congenital chest wall deformities mostly including pectus and sternal defects. Most of these deformities have mental and physiological effects. Reconstruction of these deformities has minimal morbidity and mortality rate and if they are repaired mental and physiological problems will be solved. Present study has been done in order to evaluate symptom and the surgery indication of various types of deformities and their treatment and results.Materials & Methods: In this descriptive study, 52 patients (38 men, 14 women) with thoracic deformity underwent reconstructive surgery in Razi and Aria hospitals. All patients except those with sternal cleft underwent CXR, CT scan, for diagnosis. Ravitch's technique was used in pectus cases; resection of rib was done for patients with prominent rib using pectoralis major muscle and mesh; and chondrotomy was performed on sternal cleft.Results: The mean age of the patient was 14.81±5.8 (range, 3 to30). The most common symptom was malformation, seen in 52 (%100) patients. From 52 patients, 32 (61.53%) of patients were pectusexcavatum, 10 (19.23%) were pectuscarinatum, 7 (13.4%) protrotion of ribs and 3 (5.7%) sternal cleft. In most of patients CXR was abnormal (73.68%). The severity of pectusexcavatum ranged from 3 to 5cm. For patients older than 15, two pins were used to fix sternum. Most patients had no surgery complications (8 pneumothorax, 4 pneumonia, 3 atelectasis and 2 bar infections). Surgery complications were mostly observed in patients older than 15. Two recurrences in PE and one in PC were happened.There was no mortality. Most of the patients had score of 6 out of 10 postoperative pains (42.3%). The score of pain was noticeably higher in older patients. Period of hospitalization ranged from 3 to 7 days. The period of hospitalization in patients older than 15 was noticeably more. Patients were followed up 2-6 years.15 (28.84%) of patients declared excellent level of satisfaction and the 35 (67.30%) stated good and 2 (3.84%) didn’t have satisfaction.Conclusions: Pectusexcavatum and pectuscarinatum and sternal cleft are better to be corrected in age of 8-12 years; because as patients get older the chance of complication, recurrence, and psychological problems increases. And NUSS operation must be teaching in the teaching hospital of university.

Introduction & Objective: Intraoperative hemorrhage is one of the most common complications of abdominal hysterectomy. Various methods are used to estimate the amount of blood loss, visual scale estimation is one of them. Of course blood loss estimation based on changes in hematocrit or hemoglobin levels have greater accuracy but it is a retrospective method not a clinical method. The aim of the present study was to evaluate "the visual scale estimation" diagnostic accuracy in determination of the blood loss volume during abdominal hysterectomy compared with hemoglobin and hematocrit alterations before and after surgery.Materials & Methods: In this study 74 cases of abdominal hysterectomy were evaluated in the training Al Zahra Hospital in Rasht. Intraoperative blood loss was assessed in two ways: visual estimation (based on the volume of blood in the suction device, the number of blood gauze pads accumulated during the procedure and blood loss at the operation sites and Surgical Drapes) and the other way was comparing hemoglobin and hematocrit before and 12 hours after surgery. The results of the two methods were analyzed by statistical tests (sensitivity, specify, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, Cohen's kappa cofficient & …) using SPSS version 21 for calculating the diagnostic value of visual Scale estimation.Results: In examining the convergence of bleeding by using Cohen's kappa coefficient a moderate agreement was found between Visual estimation and hemoglobin changes (kappa=0.497, P<0.0001), Scale visual estimation and decrease hematocrit were substantial agreement (P<0.0001, kappa=0.670).Diagnostic accuracy of visual estimation based on hemoglobin decreasing, was sensitivity=75%, specificity=76.1%, positive predictive value=65.6%, negative predictive value=83.3% and based on hematocrit decreasing, was 81.2%, 85.7%, 81.3%, 85.7% respectively.Conclusions: The visual scale estimation is a fast and simple way to assess abdominal hysterectomy intraoperative hemorrhage and according to moderate to substantial Cohen's kappa coefficient, this scale has acceptable accuracy with hemoglobin and hematocrit alternations before and after surgery. Therefore, it can be used to assess the intraoperative hemorrhage.

Introduction & Objective: Breast cancer is the most common cancer among women, and Iranian women a decade earlier than their counterparts in developed countries are affected. This cancer has psychologically effects, including depression. Although coping with cancer is very difficult, but as research shows it is largely dependent on psychological and medical aspects of the disease and the patient's position. This study aimed to investigate the relationship between depression and psychological well-being perception in women with breast cancer.Materials & Methods: This is a correlation study and the population included women with breast cancer at the Cancer Institute of Imam Khomeini Hospital and Jahad Daneshgahi institute who were treated over the years was 2015-2016. The sample consisted of 160 married women diagnosed with breast cancer and cases were in access sample. Data collected with Depression Inventory (Beck, 1972); Psychological Well-Being Scale (Reef 1989) and illness perception questionnaire (IPQ-R).18 SPSS software and statistical methods such as mean, standard deviation and correlation coefficients were used to evaluate data and indicators.Results: T The study hypotheses were tested by multivariate regression analysis, since the criterion variables (perceived illness) were formed of three positive aspects (clear understanding of the disease, personal control and disease control), then six hypotheses in three steps were planned and in each step a level of criterion variables (perceived illness) was predicted. All three levels and each of 6 hypothesis significantly predicted relationship between psychological well-being variables and perception of the disease (P<0.01). Also regression coefficient study between depression and 3 positive aspects of disease perception showed significant reverse relationship between depression and perception of disease (P<0.01).Conclusions: Depression significantly reverse and psychological well-being significantly had meaningful impact on the perception of breast cancer symptoms in disease women. This result confirms the hypothesis of depression and psychological well-being impact on the positive aspects of the disease perception, and also has shown the importance of evaluating and interpreting behavioral and clinical interventions in people with breast cancer.

Introduction & Objective: Severe burn is an important issue affecting public health in developing countries and one of the leading causes of death in Iran. In order to provide an overview on burn epidemiology in this country, we conducted a systematic review.Materials & Methods: Various published articles on risk factors and prevalence of burn in Iran have been searched through different databases such as SID, Pubmed, Google Scholar, Medline and Scopous. Results were collected and statistically analyzed by software.Results: We investigated 76 studies from different parts of the country. Reports showed us almost 50% of patients were less than 16 years and 60% of them were men. Flames, boiling water, burn and contact with hot objects were among the most common causes. Death is exceedingly frequent in burn (1 to 67%). About one- third of patients were children up to 5 years. Intentional burns occurred mostly among women with high mortality rate.Conclusions: Burn injuries still remain as an important public issue. Therefore, conducting more research to investigate the problem and evaluate the effectiveness of factors especially in prevention and early treatment methods is required. The prevalence of burn, mortality and the disability caused by it are high in our country. Therefore more detailed epidemiological studies with similar methods are needed in all over the country in order to reach to highly accurate statistics.

Introduction & Objective: Breast cancer is the most common cancer in women and the second leading cause of cancer related mortality after lung cancer. Survival models, a regression equation that determines what the life of a patient with a particular disease affects. The survival of patients with breast cancer as one of the main criteria to measure the impact of cancer control and treatment can be accepted. So that the survival rate is an important indicator to assess the effectiveness of diagnosis and the treatment effect of breast cancer treatment. The aim of this study was to determine the survival rate of patients with breast cancer who referred to hospital by air force mission of the Islamic Republic, using a Cox regression model.Materials & Methods: In this longitudinal study of 499 patients with breast cancer during the years 1389 to 1394 after surgery, treatment aids such as hormone therapy, chemotherapy and radiotherapy had been investigated, and clinical characteristics, treatment and condition of their survival were recorded.Results: The mean age (± SD) of patients was 3.50 (± 1.11) years. The most common type of malignancy were invasive duct carcinoma by 88% and 18% of patients with stage III disease had been admitted. One, two and five -year survival of the patient was 87%, 63% and 50%, respectively. Statistical analysis showed that age, tumor size, metastasis and hormone therapy was a significant relationship with the risk of death in these patients, so Cox regression survival model in this study, based on this proposal, and survival analysis based on it is done.Conclusions: Survival following diagnosis of cancer has decreased with the increasing of age groups. The decreasing rate for age group of 75+is noticeable. This study shows that the risk of death in patients who undergo hormone therapy are much lower than patients who were not able to hormone therapy because patients who were treated with testosterone, estrogen and progesterone receptors were positive prognosis for this disease. As well as patients who have lymph nodes involved in the early stages of the disease were identified and receive appropriate treatment, life will be more. Therefore, education to early diagnosis of breast cancer in women must be considered and followed seriously.

Introduction & Objective: Scientific journals are seen as one of information science tools and also are seen as a main criteria for entering development in a societal system, they have specific rules in disseminating information at world level. As in recent years scientific productivity especially in ISI database has been increased, to know more about surgery journals is important for researchers of this field. This paper will review Surgery journals from different prospective.Materials & Methods: This research has been done by Scientometric methods and with the use of data from JCR (ISI) database and core journals of Surgery in this database. The method which was used was to retrieve related data about Surgery journals in JCR database. Then the researchers manually, analyzed the needed data such as number of journal issues in a given year, the name of country which is publisher of journal, the name of database, indexing the journal and also the language of journal. These data, then were entered into EXCEL software for more analyzing.Results: Totally, there are 197 surgery journals in ISI database. These journal titles are published by 25 countries. In this regard, USA with publishing 96 titles stands in the first place, England with 25 titles stands in the second place and Germany with 17 titles at the tired place. Findings show that 2 journals publish 24 issues per year which means publishing 2 weeks per issue, also 1 journal publishes 16 issues per year and 1 journal 14 issues per year. In this regard 73 titles of journals publish 12 issues per year. All these Surgery journals are indexed in 24 databases. Elsevier database covers 44 journals, and in this regard stands in the top. We also found out that more than 90 percent of titles are published in English language.Conclusions: Results show that the researchers, before submitting their manuscripts to journals, should know more about the language of journal and the number of issues they publish, which gives them more chance for publishing their papers. In this regard domestic journals can follow the criteria to be entered to ISI database and enjoy more visibility.

Diverticulitis of the appendix is an uncommon cause of right lower quadrant abdominal pain which can be symptomatic or incidentally found during surgery or barium enema. The incidence of appendiceal diverticulitis very low; however, due to their higher risk of perforation, this condition should always be assessed in patients with abdominal pain. A 52-year-old male with periumbilical colicky abdominal pain presented to the emergency department. The pain started from afternoon of the day before admission, aggravated and shifted to the right lower quadrant, gradually. The patient had tenderness, guarding, leukocytosis and fever and eventually underwent surgery. The pathologic evaluation of the appendix reported acute appendicitis with appendiceal diverticulitis. Although treatment of choice in patients with appendiceal diverticulitis is similar to that of appendicitis, which is surgical resection, but this condition should always be assessed particularly in older patients and immunocompromised subjects in whom the morbidity and mortality is higher.

Uterine abnormalities including many disease and disorders of the genital area are very complex and rare. These diseases often incorrectly are diagnosed and receive inappropriate treatment. This case report related to three-days neonatal abdominal mass was detected in the initial examination, vital signs and natural appearance to the genital area was normal. Also in touch an abdominal mass was palpable in the hypogastria. VCUG and CTscan were performed and patient with vaginal hydrometrocolpus were taken to operating room and underwent treatment. The catheter was inserted in the vagina to drain but seen in other uterine so drainage was performed then a week later the patient discharged with a good condition. Many studies have noted the signs for about12-14 years, but in this case happened early diagnosis. For early detection cooperation pediatricians, obstetricians, radiologists and pediatric surgeon seem necessary.