Iranian Journal of Surgery
Year:2004 | Volume:12 | Issue:33|Papers Count:18

Chest tubes are placed in many thoracic operations. Patients are frequently concerned for the chest tubes as they cause too much pain, prolonged hospital stay and restrict patient ambulation. Chest tube insertion in many cases is an important part of surgery and sometimes is the principal operation. There are few prospective studies describing the best method of chest tube insertion address to questions such as; appropriate size of tube, best time for removal, suitable place of insertion and also suction policy and care of chest tube. Most surgeons apply different policies based on which place they have been trained. Questions related to pleural space, negative pressure of pleural cavity, rules of pleural cavity drainage, special manner of chest tube operation and causes of air leakage are ambiguous for many physicians, nurses and other persons who take care of patients. In this review we try to consider clinical problems in detail and find answers based on literature review and our experiences.

Introduction & Objective: Cardiac surgery in Iran has been associated with different facilities, equipment and patient populations in comparison to countries from which most of the academic papers used for identification of risk factors related to outcome and subsequent construction of risk stratification models originate from.Material & Methods: During 15 months all of patients admitted for adult cardiac surgery using cardiopulmonary bypass in a university affiliated teaching hospital were enrolled in a prospective study. Appropriate statistical tests were used to analyze data for mortality and morbidity.Results: There were 730 adults (63% male, 37% female), with an age range from 16 to 82 (mean 51.4 ± 14.4). A mortality rate of 5.3% and morbidity of 14.8% (major + minor) were observed in the whole group. Factors correlated with mortality were: age (p = 0.019), emergency surgery (p < 0.0001), redo cardiac surgery (p = 0.01), LV aneurysm (p < 0.001), presence of catastrophic states (p < 0.001), low ejection fraction (p = 0.04), history of hypertension (p = 0.05), the individual surgeon operating (p < 0.0001), and CPB duration (p < 0.0001). Factors affecting morbidity included: female gender (p = 0.04), age (p = 0.03), emergency surgery (p = 0.001), redo surgery (p = 0.008), and catastrophic states (p < 0.001). Conclusions: The mortality in our setting may be compared with reports presented in the literature. Age, emergency surgery, redo cardiac surgery, and catastrophic states are statistically related to both mortality and morbidity.

Introduction & Objective: Isolated orbital fracture is rare. History should be taken with great care and patients must be examined by an ophthalmologist. If the risk of corneal dryness is present; emergency eyelid Closure or fracture reduction should be performed. Operation must be done as soon as possible in order to prevent fibrosis in damaged tissue.Material & Methods: Records of 42 patients who: were admitted of 15 Khordad hospital between 1379 to 1382were studied retrospectively. Patients had a mean follow up of 1 year (6 months to 2 years). Results: Most of our patients were male (92%) and car accident was the main cause of trauma. The most frequent orbital fracture was impure type blowout frequent of orbit. Ten patients underwent orbital floor reconstruction with bone graft and two cases were re-operated due to lower eyelid ectropion. Conclusions: All the patients that referred to this hospital suffered from considerable bone and globe displacement. All patients were operated with satisfactory results. Helmet wearing in motorcyclist may important role to prevention of craniofacial trauma specially orbital trauma.

Introduction & Objective: Ovarian cancer is one of the most prevalent malignancies in women and its incidence has increased during the recent years. Thus early diagnosis and appropriate treatment methods are essential in order to improve the survival rates. Material & Methods: In this descriptive retrospective study 250 cases of ovarian cancer from different hospital of Isfahan during 17 years were evaluated. Information on age, marital status, pariety, OCP consumption of the patient, the interval between first clinical manifestations and diagnosis, pathological type and stage of cancer were collector. Results: The majority of patients were between 40 - 60 years with a mean age of 51.62:t13.82.Mostof patients were married (89.6 %) and of those married; 6% were nullipar, 22% had less than or equal to 3 pariety and 72% had more than 3 pariety.Epithelial ovarian cancer was found in 78.8% of patients21.2% of them were suffering form non epithelial ovarian cancers. Most of the patients had a stage III cancer (37.6%) and the frequency of stage IV, stage I and stage 11cancers were 39%, 9.6% and 8.8% respectively.Patients with stage I ovarian cancer were mainly between 20-39 years old (44.9%) and those with other stage were mainly between 40-60 years old (stage II:40-91 % , stage III: 55.32% and stage IV 56.47%). The majority of patients with ovarian cancer (in all stages) were diagnosed 1 to 6 months after the onset of symptoms (52.8%). The most frequent symptom was abdominal pain (34.8%) regardless of the stage of the cancer. The most pathological type of ovarian cancer (in all stages) was Epithelial type (78.8%) with the Germ cell type being the second most frequent (15.2%). Conclusions: According to the results the frequency of ovarian cancer is a rapidly increasing specially during per menopausal and the stage at diagnosis is relatively high which is comparable with...? Thus with early diagnosis and applying appropriate treatment methods we might be able to improve prognosis.

Introduction & Objective: Despite the decline in the incidence of peptic ulcer disease, neither the incidence nor the need for surgery for the emergent complications of ulcer has changed significantly during the past three decades. The medical treatment of peptic ulcer is highly successful, and eradication of H. pylori reduces ulcer recurrence. Thus, precious complex acid - reducing procedures are substituted by simple closure of the perforation with for without an omental patch or by suture less techniques. Laparoscopic techniques for Perforated Peptic Ulcer (PPU) have evolved in the past few years and non - randomized and randomized studies suggest that laparoscopic repair is feasible, efficacious and safe. In this study we have reviewed the role of laparoscopy in management of PPU. Material & Methods: We have reviewed a series of 14 patients with PPU who underwent laparoscopic surgery in Arad general hospital, between 1995-2003. All of the procedures were done by an experienced laparoscopic surgeon. Three ports were inserted in abdominal wall. Simple closure of the perforation with one or a few simple sutures by 2/0 silk and irrigation of the abdominal cavity using 6-8 liters of normal saline was performed. In 50% of patients an omental patch was fixed to the site of repair. Results: 12 patients (86%) were male. The mean duration of pain was 30 hours (12-96 hrs), the mean operating time was 75±12 min (60-120 min), and the mean hospital stay was 4±2.1 (:3-8) days. Over all success rate was 86% and conversion to laparoscopy was necessary in 2 cases due to a giant ulcer in one case and inadequate localization in the other. Only one patient (7%) was re-operated two weeks later because of severe pyloric deformity that caused gastric outlet obstruction. There was no mortality and the mean follow up time was 5 years (6 months to 8 years). Conclusions: Finally we conclude that laparoscopic repair of PPU is technically feasible, safe and not only carries an acceptable results compared with convectional surgery, but also has some advantages eg.: less scarring, lower incidence of incision hernia, wound infection, post operative pain and shorter convalescence period for patients.

Laparoscopic appendectomy was attended and studied almost contemporarily with laparoscopic cholecystectomy. During more than a decade of development in laparoscopic surgery a couple of controlled studies have been performed concerning this new approach. Findings indicate some advantages and some limitations. The goal of present study is to evaluate these findings. This is a prospective randomized case control clinical trial. Findings revealed less postoperative pain, earlier oral feeding (soft diet) and shorter postoperative hospital stay in laparoscopic group. Also, no patient in this group developed wound infection.

Introduction & Objectives: Inguinal hernia is the most common hernia in both sexes and groin lumps account for up to 10% of surgical outpatients.An increase in intraabdominal pressure due to exercises and heavy physical activity is a predisposing factor of inguinal hernia. Our aim was to compare the frequency of inguinal hernia in manual workers and clerks.Material & Methods: Six hundred cases were evaluated. A questionnaire consisting of history and physical exams of the groin was completed for each case. The two groups were matched for age, duration of work (years), smoking, chronic cough, prostatsim, constipation and history of varicocele operation. Results: Inguinal hernia was found in 24 manual workers (8%) and 8 clerks (2.6%). Conclusions: This study shows that high intraabdominal pressure due to exercise and heavy physical activity is one of the important predisposing factors of inguinal hernia.

Introduction & Objectives: Acetabular fractures commonly occure in accident involving the weight bearing chain of the body. Our aim was to evaluate the surgical results of these fractures. Material & Methods: All patients with actabulum fracture requiring surgery in Sina hospital between 1378and 1381were included in this study. Patients with less than three months of follow up were excluded. Patients underwent a physical examination, a pelvic x-ray and if possible a bone scan in the final visit. Results: In all we studied 25 cases of which 23(92%) were male and 2(8%) were female. Patients had a mean age of 28.5 years (15-60 years) and with a mean follow up time of 13 months (3-36 months). The major cases of injury in our study was motorcycle-car accident which occurred in 18 cases (72%). The most common approach was kocher Langen Beck in which was used in 17 cases (%68). Other approaches such as Ilioinguinal approach and the combination of kocher Langen Beck Ilioinguinal was used in 3 cases (12%) and 5 cases (20%) respectively. Associated injuries were discovered in 19 cases (72%) which mainly consisted of injuries to the lower extremity. The most common type of fracture were A (9 cases, 36%) and B, (7 cases, 28%). In 15 cases (60%) there were associated hip dislocations accompanied by acetabulum fractures. In the last visit, the Harris hip score was less than 70, 71-80, 81-90 and 91-100 in 12%,20%,24% and 44% of the cases we had avascular necrosis in 4 cases (16%), heterotypic ossification in 2 cases (8%) and hip arthritis in 3 cases (12%). We had good results regarding of motion, incongruity of articular surface and pain. There were 7 cases with nerve injury (28%), 5 of which were personal nerve injury and 2 were injuries to the lateral cutaneous nerve of the thigh. The two most common indications of surgery were displacement and joint incongruity (32.2%). Conclusions: Our results show that if surgical treatment of acetabular fracture is carried out appropriately in cases where surgery indicated; good results will be achieved. Mianfull statistical differences were not achieved since the destribution of the variables were not normal yet we might be able to see a better result in young patients with simple fractures whom undergo surgery soon after the injury. Relatively another problem in our study was the short duration of follow up; and the relative low rate of avascular necrosis and destructive joint disease might be due to that.

Introduction & Objective: Because of heterogeneity in the etiopathology of cancer nowadays the oncoproteines and tumor markers are important agents in managing cancer patients including breast carcinoma. Among oncogenes, C-erb B2 (HER-2) and P53 are the most famous prognostic factors for breast carcinomas. In the international literatures 20-23% of Breast Carcinoma cases are positive for B2 or P53 amplification and oncoproteines production. But in this research the rate is showed two times higher. Material & Methods: In this research 191 Breast Cancer patients were evaluated for oncoproteines and Estroeid receptors comparing with clinical indicators all of this cases were managed with the author in a private clinic. Results: Among 191 cases, 63% were C-erb B2 positive and 55% were P53 positive. ER and PR were 65 and 67 percent positive. Conclusions: This research is confirmed the efficacy of oncoproteines as tumor maker, in Iranian breast cancer patients and because if the severity of them more investigations and researches are recommended.

Introduction & Objectives: Reconstruction of extensive soft tissue defects of ~e is one of the most important problems in plastic surgery. This problem may results from Infections, burns and tumor resection. Reconstruction techniques include: Fasciocutaneous flaps (saphenous, postero lateral thigh), muscular flaps (vastus lateralis, vastus medialis and gastronomies) and free flaps which are the last choice for reconstruction of knee defects. We used lateral and distal thigh flap to cover knee defects in 15 khordad hospital during 1380 to 1382. Material and Methods: During 2 years four patients that suffered from extensive soft tissue damage of the knee due to burns were treated. Debridement and primary care were done and defects were covered with gastronomies flaps and with remains of proximal soft tissue defect. Defects were covered by lateral and distal thigh flap. This article reports the analysis and results of this procedure. Results: During this time two patients (17 and 30 years old) were treated by this flap with a mean hospital stay time of 20 days and a mean 15 months of follow up. Conclusions: This flap was used successfully. Usage of this flap for the same conditions is suggested due to an easy technique and a shorter operation time.

Malignant Small Round Cell Tumor (MSRCT) is a wide spectrum of malignant tumors, which commonly involve the chest wall. It's often seen in the second and third decade and is more common in men. The primary origin of the tumor is from the sympathetic nervous system and has its own specific pathological pattern. Even with the help of immunohistochemistry and genetic techniques the diagnosis is difficult since a wide spectrum of Malignancies have similar pattern. Most of these tumors are inoperable because of their wide extensions, thus invasive techniques of chemoradiotherapy and surgery if possible are included in the treatment of these malignant tumors. The mean duration of survival was eight months. In this paper in addition to a definition of this disease a retrospective study of seven patients at Ghaem hospital during ten years from 1370 to 1379 is presented.

Perforation of the esophagus is a true emergency.Nowadays, endoscopic interventions are the most common cause of perforation. Early diagnosis has an important effect on treatment results and decrease of morbidity and mortality rates. If the diagnosis is delayed, especially in intrathoracic perforations, morbidity and mortality rates increase regardless of the type of operative measures. There is no consensus on the type of operation for late intrathoracic perforations and many different techniques are used including simple chest tube drainage, thoracotomy and esophagectomy with or without primary reconstruction and primary repair without resection. Five days after an intrathoracic esophageal perforation in a 70-Y-old woman it was repaired successfully through a right thoracotomy. Clinical course and details of technique are presented.

Internal hernia represents only a small fraction of the patients with intestinal obstruction, however 50% of Para duodenal hernia present as an acute intestinal obstruction the case is a 28-year old man with presentation of complete bowel obstruction. Diagnosis was confirmed through physical examination and abdominal radiography. Laparatomy was performed during which total herniation of small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. A left paraduodenal hernia was diagnosed. The hernia was repaired by reduction and closure of the mesenteric defect.