Iranian Journal of Surgery
Year:2008 | Volume:16 | Issue:2|Papers Count:19

From the last decade of 19th century and the beginning of modern era in surgery; peritonitis has been always considered a serious lethal disease.In the past hundred years with the advanced knowledge about the bacteria and their role in peritonitis, and the discovery of antibiotics an astonishing progress was made in the treatment of peritonitis. Furthetmore, anesthesiology made medical and surgical treatment applicable to most cases of peritonitis and decreased the mortality and morbidity dramatically.Advents in radiology, ultrasound, and CT-Scanning and nuclear medicine along with MR Imaging opened a new horizon for exact diagnosis and proper treatment.Laparoscopic surgery and percutaneous needle aspiration and application of stents guided with ultrasound, CT and MRI made treatment easier for patients; physicians and surgeons.

Introduction & Objective: At the present, cancer is the third factor in mortality and constitutes. The second grand of non-transmitted chronic disease. The colorectal cancer is among the most important kind of cancer throughout the world. It is the most prevalent cancer of the gastrointestinal system. It constitutes about 70% of the mortality due to cancer. In this project we have made an epidemiologic study of colorectal cancer in Arak for a period of ten years.Materials & Methods: In this descriptive study, the documents of 274 patients with colorectal cancer hospitallized in Vali Asr, Imam Khomeini and Ghods hospital in Arak during 1994-2004 were evaluated. The extracted data consisted of age, sex, stage of disease with, type of cancer, the primary symptom at the time of referring time were analyzed by SPSS software.Results: There were 54.7% men and 45.3% women. The mean age of the patient's age was 56.22 and 17.5 percent of them were less than 40 years old. Most patients were in the third stage of cancer at the diagnosis time and the most prevalent type of the cancer has been adenocarcinoma. The most prevalent region of anatomic lesion was rectum. Rectorrhagia was reported to be the most prevalent symptom at the first referral.Conclusions: Considering the high frequency of the patients with age less than 40 years and the youthfulness of the society genetic problems and environmental risk factors should be considered. Assessment of risk factors and the isolation of patients should be done at the earlier stage. Considering the high frequency of recto sigmoid tumors in our study, it seems that fiber optic sigmoidoscopy method has important role in the early diagnosis and treatment of these patients in Iran.

Introduction & Objective: Traumatic asphyxia is a commonly used designation of a rare syndrome related to severe compressive trauma to the thorax. In this study we report ten cases of this syndrome.Materials & Methods: In evaluation ten patients were seen exhibiting the stigmata of traumatic asphyxia. Data consisting of sex, age, mechanism of injury, clinical finding, associated injuries, length of hospitalization and outcome were studied.Results: There were 8 male and 2 female patients ranging in age from 4 to 56 years. Mechanism of injury was crush due to earthquake in one patient, entrapment beneath a vehicle in one, entrapment beneath a heavy stone in one, crushing with heavy objects in two and car accidents in five victims. Subconjunctival hemorrhage, craniofacial edema and petechiae developed in all patients. Most of the patients suffered some associated injuries including 2 liver injuries, 2 rib fractures, 2 diaphragmatic injuries and one diastases of pubis. Length of hospitalization ranged from4 to 27 days. There was no mortality.Conclusions: Traumatic asphyxia is a rare but important syndrome after thoracoabdominal blunt trauma that should be kept in mind for early diagnosis and management. It can be associated with other organs injuries.

Introduction & Objective: Post operative bleeding is an important problem following cardiopulmonary bypass (CPB). In normothermic condition may, CPB improve the function of coagulation factors and maintain hemostasis; thus decreasing post-operative bleeding. This study aimed to compare postoperative bleeding and blood products requirements following coronary artery bypass grafting (CABG) in hypothermic and normothermic CPB groups.Materials & Methods: This randomized trial performed on 63 candidates of primary isolated CABG. Patients were randomly divided in to normothermic (N) and hypothermic (H) groups. In group H, the temperature was lowered to 30° and mean arterial pressure (MAP) was maintained in the range of 40-65 mm- Hg. In the group N, patients did not cool down actively and the temperature was kept in the rang 35o-37o and MAP was maintained between 60-90 mm-Hg. Blood loss and blood products requirement assessed 12 and 24 h post operatively.Results: There was no statistically significant difference in age, weight, pre-operative LVEF, number of affected coronary arteries, NYHA class, and CPB time between two groups. Blood loss during first 12 and 24 post operative hours were, respectively 395.67 ml and 512.67 ml in group N and 441.82 ml and 626.97 ml in group H (P=0.1 and 0.5 respectively). The mean values of PT and PTT times 6 hours post operation were not statistically different between the two groups, but the platelet count was significantly higher in group N (P=0.003). There was no significant difference in the blood products utilization.Conclusions: Our data suggests that hypo- and normothermic CPB does not influence post-operative blood loss during the first 24 hours in the patients undergoing primary isolated CABG. The only significant difference between the two groups was platelet count which did not result in increased platelet requirement.

Introduction & Objective: The traditional treatment of palpebral bags of the lower lid is the resection of excess fat surgically. In 1986 Sachs and Bosniak and in 1986 de la Plaza and Arroyo reported a new technique for the repair of palpebral bags that consisted of pushing back the herniated fat to the orbit and the retaining it by the running sutures of the capsule palpebral fascia (CPF) in the periosteum of inferior orbital rim. The purpose of this manuscript is to compare this procedure with traditional fat removal bleparoplasty.Materials & Methods: This report describes a prospective evaluation of 10 female patients who underwent CPF repair for herniated lower lid bags. All patients were evaluated at 6 weeks and 6 month postoperatively.Results: This manuscript shows that in this technique the rate of pain hemorrhage and hematoma is less than fat removal procedure. In addition, lid fat pads don’t change and only were returned lack into primary lodges. All patients were female between 35-60 years old. CPF is relative dense structure that can protect fat compartments, but is weak in lat compartment. The amount use of analgesic and sedative is less than usual. The difference between our procedure and that of de la plaza group was the use of separate sutures which has advantages.Conclusions: Our results show that the CPF hernia repair procedure carries less discomfort and pain intraoperatively in comparison with the fat removal technique and may be less prone to bleeding and possible hematoma formation after surgery. In the addition, in comparing the traditional lower blepharoplasty with the fat removal, hallowing of the lower lid or the risk of sunken eye looking of the globe will not occur with the CPF repair technique.

Introduction & Objective: According to the high incidence of hydatid cyst in Iran and less information about this disease and patients in children, this study was performed to evaluate the patient's characteristics, and the outcome of treatment in four children's surgical centers in Tehran (Mofid, Bahrami, Taleghani and Amirkabir Hospitals) from 1987 to 2007.Materials & Methods: In a descriptive retrospective study, data were collected from the medical records of the patients in the archives of mentioned surgical centers, and using the international classification disease (ICD10). The medical records of children with the ages of 1 to 14 years old whom had definite hydatid cyst disease in different organs were included, and analysis of variables such as gender, age, symptoms, cyst localization, diagnostic tools, operative techniques, morbidity, mortality, recurrence, hospital stay and the outcome of treatment.Results: The patients consisted of 61(53%) boys and 55(47%) girls, with the ages ranged from 2 to 14 years old. The mean age was 10.8±5.6 years old. The incidence rate was increased by age. 157 cysts were found in116 patients, 87(55.42%) cases in lung and 61 (38.86%) cases in liver. The most common symptom in lung was cough and in liver was abdominal mass. 114 patients underwent surgical intervention, but two patients refused surgery. Recurrence accurred in 7 cases (6.14%), mortality in 2 (1.72%). The most common complication was wound infection in 5 cases, and the mean length of hospitalization was 9 days. In 98% of our patients the type of parasit was echinoccocus granulosus.Conclusions: In children the incidence of hydatid cyst was increased by age, and the most involved organ was lung. We suggest more investigation for getting more information about different situations of this disease in children.

Introduction & Objective: Nonunion of tibia is one of the most popular complications in orthopedic surgery and there are many treatment methods for it, with their advantages and disadvantages. We try to select the best treatment method for this problem.Materials & Methods: 22 nonunions of tibia were studied, some with previous failed surgeries and some with bone defects. At first we excise all necrotic and infected tissues, then we insert ilizarov device and made osteotomy far from the nonunion site and began bone transport, 1 millimeter daily until we filled defect.Results: All patients were male and we had no problem during transport period. Finally, all have union but 18 of them had malunion and 14need bone graft in ducking site. There was no problem in the distracting osteogenesis site of osteotomy. In all cases we saw some decrease in the movability of the ankle. In one case we had recurrent refracture and in 4 cases we have minimal (less than 2 centimeters) shortening.Conclusions: In general, and considering of all aspects, because in all patients finally we see union regardless of some degrees of malunion and decrease in the range of motion of ankle, they all return to their daily activities. So, it seems that ilizarov device is a good method, with low morbidity in the treatmented of nonunion of tibia.

Introduction & Objective: Many of the Carpal Tunnel Syndrome (CTS) patients have sever median nerve involvement at the time of admission. Some of the CTS Patients complain about symptoms in ulnar nerve territory; some of recurrence of symptoms after Carpal canal release. The aim of this article is the presentation of a new surgical technique and its result in the CTS patients.Materials & Methods: In this study 24 patients and 36 CTS hands were operated upon by the new technique and their results were evaluated before and 6 months after their surgery.Results: Median nerve involvement was bilateral in 50%, RT side in 33% and LT side in 17% of the patients. 62.5% of the patients were categorized in the sever type. Using Michigan's hand questionnaire, significant improvement occurred in hand Function. Only in one patients scar tenderness was continued, in majority of patients, preoperative symptoms were subsided after six months after the operation.Conclusions: Most of the CTS patient's who are upon operated have sever median nerve involvement. The use of incision in the modified classical technique enables neurolysis more proximally. Carpal tunnel roof reconstruction by Z plasty or flexor retinaculum flap, provided better median nerve gliding and lessen's symptom recurrence and the need for reoperation. The use of modified classical technique is safe and effective in CTS patients' surgical treatment.

Introduction & Objective: The first documented laparoscopic cholecystectomy was performed by Erich Mühe in Germany in 1985. In the developed countries, currently over 90% of cholecystectomies are performed laparoscopically. It is generally believed that laparoscopic cholecystectomy has better results than open cholecystectomy in term of patient's compliance and early return to work but it seems that the final outcomes are not different. New studies show that open cholecystectomies with small incision are a good alternative for the selected patients. The aim of this study was to compare the efficacy of laparoscopic and open cholecystectomy in the clinical outcome and patient satisfaction.Materials & Methods: Between January 2005 and August 2006, 150 patients with a diagnosis of symptomatic gallstone, were assigned for cholecystectomy. They were divided in two groups; the first group (n=91) were assigned to open cholecystectomy in Baqiyatallah hospital; the second group (n=59) were assigned to Laparoscopic cholecystectomy in Milad hospital. Then they followed for their symptoms of recovery and satisfaction four month later.Results: After four months follow up there was no differences observed in symptoms of recovery and patient satisfaction (62.6% vs. 62.7) between the two groups. The improvement rate of abdominal pain after laparoscopic and open cholecystectomy seems to be very good and equivalent for 63% of the patients in the two groups, although improvement of symptoms in dyspeptic patients were lower, but it was similar within the both groups.Conclusions: Laparoscopic surgeries are more expensive because of its modern equipments and expensive Instruments. Open cholecystectomy, especially with small incision, is an acceptable alternative for the treatment of symptomatic gallstone disease. It is recommended to have the open cholecystectomies with small incisions for the patients who don’t need to return to work early or for the patients who cannot offer for laparoscopic cholecystectomy.

Introduction & Objective: Esophageal Carcinoma is a rapidly spreading fatal disease endemic in north Iran. Esophagectomy is the palliative management. Functional outcome of this major surgery is the expected result in the form of relief from dysphagia. We studied the post-operative survival rate and functional outcome of esophagectomy.Materials & Methods: From 1991 to 2001, 240 patients afflicted with esophageal carcinoma underwent esophagectomy at the Razi University Hospital, Arya and Golsar Hospitals of Rasht. The annual survival rate and the quality of life in terms of relief from dysphagia were studied using a self reported questionnaire and case records of 192 patients. Data were analyzed with the help of SPSS 11.5.Results: The 4-year survival rate for all patients was 38.0%. The 1-year, 2-year and 3-year survival rates were 80%, 61%, 52% respectively. Of these patients 61% complained from mild dysphagia, 25% of the had severe dysphagia, 6% had odinophagia and 18% complained of Heart burn, and 28% patients needed dilatation twice or thrice during3 years of survival. Only 14% were asymptomatic.Conclusions: The results of this study in north Iran suggests that 4 years after esophgectomy surgery, the survival rate was 38%, but only 14% of all cases enjoyed normal functional outcome.

Introduction & Objective: Laparoscopic cholecystectomy is the safe and gold standard treatment in most patients with gallbladder diseases worldwide. Routine drain placement after laparoscopic cholecystectomy is controversy and most surgeons use it to prevent collection of blood, bile or pus. But drains can cause pain, infection, more prominent scar and delay in discharge of patients. This study assessed drain efficacy in laparoscopic cholecystectomy by assessment of volume and contents of drained fluid, and its advantages and disadvantages.Materials & Methods: This study was performed on 92 patients in Dr. Shariati hospital during 2007-8 underwent urgent or elective laparoscopic cholecystectomy. Demographic characteristics of patients, indication of surgery, duration of surgery and postoperative pain and events were collected. Value and content of drained fluid, and postoperative hospital stay were recorded and analyzed.Results: Drains were fixed in 59 (64.1%) patients and 33 (35.9%) patients did not have drain. Mean drained fluid was 40.4±28.4 milliliters (range: 10-300 cc). Fluid was serous or serosanguineous in all cases, no fresh blood or bile in any case. In most cases (90%) fluid volume was less than 100 cc. None of the patients without drains suffered abdominal collection, percutaneous drainage or repeated surgery. Pain was more in patients with drains. Using visual analogue score (0-10), pain was scored 1.5±1.2 in patient without drain and 2.2±1 in patients with drain, 12 hours after surgery (P-value=0.018). Mean postoperative hospital stay was 1.3±0.5 days in patients without drain and 1.8±0.6 days in the other group ((P-value<0.0001).Conclusions: It seems that drains in laparoscopic cholecystectomy evacuate little insignificant fluid. Drain placement can cause more pain, longer admission period and more cost. It is recommended not to place drains were not necessary cases. Reducing use of drains through correct clinical judgment can decreases its disadvantages such as pain, infection, patient anxiety, longer admission period and costs.

The use of narcotics is a worldwide health problem. Systemic lethal viral infections (AIDS and Hepatitis) and bacterial infections of soft and hard tissues are serious complications in the users. It plays an important role in mortality and morbidity. Incidence of hard tissue infection among IV narcotic users is rare. This review while introducing narcotic users with osteomyelitis, summarizes recent information on hard tissues associated with heroin drug user.

The vertebral artery (VA) originates from the first part of the subclavian artery. The incidence of the aberrant origin of the left VA directly from the aortic arch has been investigated in some societies and has been estimated to be from 1 to 5 percent. Aortic origin of the right vertebral artery is a rare variant. The incidence of this anomaly has not been reported in Iran. During a routine dissection of a white 30-year-old man, the VA originating from the left subclavian artery was not observed, but the aortic arch had an additional artery that had entered into the foramen transversarium of the 6th cervical vertebra. In assessment of the posterior cranial fossa both left and right VA were observed. Other subclavian branches and the origin of the right vertebral artery were normal. The lack of the left VA originating from the subclavian and the presence of an aortic arch originated artery with a similar path to VA, suggests the aberrant origin of the left VA from the aortic arch. The knowledge of these potential variations in the vertebral artery origin could prevent surgical complications or wrong diagnosis in supraaortic vascular surgery and diagnostic procedures like angiography.

Writing case reports in medical texts data back to Hipocrates time. Case reports may include primary cares, rare signs, new ways of diagnosis and treatment, and possibly reports about education and research. Case reports are generally involve 1500–2500 words in length with 20–30 references; and an abstract of 100– 250 words. The introduction should not more than three paragraphs. In the literature review, one should make use of the relevant data bases. The discussion port is the most important section of a case report. The discussion should evaluate the unique features of cases and accuracy of the data.