Iranian Journal of Surgery
Year:2017 | Volume:25 | Issue:2|Papers Count:19

Facial nerve palsy is very common and all expression muscles of the face are paralyzed as a sequence. Inability to blink, facial asymmetry and oral incontinence following the paralysis leading to physical, psychological and social problems and reduce the quality of life. Paralysis of the oral cavity muscles can interfere with eating, drinking, talking and smiling. Many different types of procedures introduced for reconstruction of movement around orbital or oral cavities in these patients. In the first part of this study we discuss about the etiology and pathophysiology of the entity, signs and symptoms, and also peri-orbital treatments. In this section we review the oral problems and the options for their treatments. Primary repair, using nerve grafts, nerve transfer, regional muscle transfer, free functional muscle transfer accompanied with nerve transfer and static slings are the techniques that will be discussed. Also the maseter nerve as a newly re-introduced nerve transfer for acute and delayed reconstructions will be described.

Introduction & Objective: Nasal obstruction is one of the oldest and most common complaints of people that can be caused by septal defect, polyp and rhinitis allergic and inferior turbinate abnormalities.The best technique to reduce the size of the inferior turbinate and maintain physiological function, preserving mucosal surface by reducing the sub mucosal tissue. Therefore, this study was conducted to treat turbinate hypertrophy with using diathermy technique controlled.Materials & Methods: His study was conducted on 96 patients with airway obstruction due to turbinates hypertrophy with using diathermy technique controlled in Shahid Modares Hospital. Sampling was conducted convenience. Data were collected through clinical examinations, the results of CT scans and paraclinical tests, complete the checklist and record the results of the preliminary examinations nasal and septum before surgery. Diathermy technique controlled was conducted on patients with moderate and severe hypertrophy with using monopolar cautery grade 40 and through the cannula 5 mm. Airway complications and recovery of all patients at interval of one month after surgery were follow and evaluated by referring patients to hospital. Finally the data were analyzed with the McNemar and Kruskal test in SPSS (V.22).Results: Results showed a significant difference in reducing symptoms such as feeling an unpleasant smell, runny nose and a creation of crest in recovery of patient after surgery controlled diathermy, as well as significant improvement created in respiratory status and condition of smell (P<0.05). However, a significant difference was not observed In terms of reducing hoarseness snoring sound (P>0.05).Conclusions: Many surgical techniques for treatment of inferior turbinate hypertrophy such as complete or partial turbinectomy, turbinoplasty, laser, cauter and crayotherapy, reducing volume with radio frequency have been used. This study suggests, controlled diathermy as a effective method for reducing bothering symptoms after rhinoplasty.

Introduction & Objective: Ileus is one of the common complications in hospitalized patients as well as it is the most common reason of delay in discharge from the hospital due to abdominal surgeries.Present study with aim of investigating the results of chewing gum on bowel movements of digestive system after appendectomy was designed.Materials & Methods: In this clinical trial using the related sample size formula 40 patients’ means that underwent appendectomy surgery in Besat- Hamedan Medical Center were randomly classified into the intervention and control groups (20 people per group). Inclusion criteria for the study included the age of over 15 and having appendectomy surgery and the exclusion criteria included hypothyroidism, hypoparathyroid glands, electrolyte disorders, neuro muscular diseases and drug addiction. Method of anesthesia was similar in both groups. For the case group the chewing gum manufactured by the same factory and in the same flavor was prescribed within the four, ten and eighteen hours after the patient's recovery. No treatment was applied to the control group. One hour after the patient’s recovery and stabilization of the vital signs, the bowel sounds were examined by stethoscope by researcher in the case and control groups every two hours. The researcher evaluated flatulence and defecation by asking the patients. The collected data were analyzed by SPSS version 17 and the descriptive statistics were used in the required cases and the t-test was used for the evaluation of significance of the data. The significance level of data is considered lower than 0.05.Results: The average time to hear the first bowel sound in experimental group was 3.30 ± 1.17 hours and in control group it was 2.60 ± 1.23 hours. Therefore there was no significant difference (P=0.073) between the experimental and control groups. The average time to gas-passing in experimental group was10.90± 3.52 hours and in control group it was 17.50 ± 9.90 hours that showed a significant difference (P=0.008) between the experimental and control groups. Average time to defecation in the experimental group was 25.40 ± 5.03 hours and in control group it was 37.70 ± 13.98 hours. Therefore there was a significant difference (P=0.001) between the experimental and control groups. The average time to receive oral feeding in the experimental group was 17.75± 4.88 hours and in control group it was 18.50 ± 5.18 hours (P=0.641). The average time to leaving the sickbed in the experimental group was 8.85 ± 5.60 hours and in control group it was 10.55± 4.29 hours (P=0.28).Conclusions: According to the results of this study, the average time to gas-passing and defecation in gum recipients group was significantly less than the control group. Complementary studies and finding ways to find out the chewing gum effects on reduction of Ileus time without questioning the patient about the first gas-passing and defecation after surgery was recommended.

Introduction & Objective: Breast cancer is known as the most common site-specific cancer as well as it is referred to as the second cause of mortality for women. Literature indicates that the most important prognostic factors are addressed by lymph node involvement, the activity of estrogen and progesterone receptors, tumor size, tumor grade, histologic type, and epidermal growth factor. Published researches address that these prognostic factors and the relationship between them are known as important indicators to assess the effectiveness of diagnosis of a treatment method and a treatment method influence of the breast cancer. However the published researches do not address analyzing the impact of the receptor status on lymph node involvement and the impact of the relationship between the prognostic factors on survival of patients with breast cancer. This study attempts to not only investigating the impact of the receptors on lymph node involvement, but also the survival of breast cancer patients considering simultaneously the receptor status and lymph node involvement prognostics, is analyzed.Materials & Methods: In this study, 1822 patients diagnosed with breast cancer have been considered. These patients after treating in the period of 2007 till mid 2016 were cared under adjuvant therapy such as hormone therapy, chemotherapy and radiotherapy. In this study, receptor groups are defined in 8 categories based on different combinations, as well as the number of lymph nodes involvement are categorized in 4 branches (i.e. no lymph node involvement, between 1-3 lymph nodes involvement, between 4-9 lymph nodes involvement, and more than 9 lymph nodes involvement). Receptor statuses of these patients were analyzed using the logistic regression approach. In this research, the statistical software R has been used for data analysis.Results: The age mean (± Standard deviation) of the patients were addressed by 50.45 (±11.47) years. Lymph node involvement was recognized for more than half of the patients (933 people i.e.51.20%). The frequency of each 8 receptor groups were obtained as (263 individuals) 14.43%, (222 individuals) 12.18%, (762 individuals) 41.82%, (138 individuals) 7.57%, (40 individuals) 2.19%, (70 individuals) 3.84%, (11 individuals) 0.54%, (22 individuals) 1.20%, respectively. Group 3 of the receptor status (i.e. simultaneous prognostics of positive estrogen, positive progesterone, and negative HER2), addressed the highest percentage of (762 individuals) 41.82%, and Group 7 (i.e. simultaneous prognostics of negative estrogen, positive progesterone, and HER2-positive) addressed the lowest percentage of (11 individuals) 0.54% among the other groups.P -value is addressed by 0.01 and 0.05 for estrogen and HER2, respectively, when the impact of receptors on lymph nodes has been analyzed.Conclusions: This study indicated that: 1) there exist relationship between estrogen receptors and Her2 with lymph node involvement, so that these receptors impact on involving the lymph nodes.2) In the case that the prognostics of positive estrogen, positive progesterone, and negative Her2 occur simultaneously, the receptor status addresses the best condition of the survival for a patient with breast cancer compared to other groups.

Introduction & Objective: Flap necrosis caused by inadequate blood flow to a common complication of surgery is reconstructive. Since the angiogenic potential of stem cells has been shown, the purpose of this study was to evaluate the effect of adipose-derived stem cells autograft rate of random skin flap angiogenesis animal model rat.Materials & Methods: This experimental study in 1394 in laboratory animals Hazrat Fatima (SA) was conducted. In this study, 24 male Sprague-Dawley, rats weighing 300-350 g were divided into two groups after anesthesia. In the study group of stem cells from fat tissue autograft were inguinal area and cultured and then injected subcutaneously at the base of random flap in the control group received saline.On days 7 and 14 photographs were taken to determine the extent of necrosis flap and then the flap base for histopathological examination on day fourteen and counting the number of capillaries were sampled. At the end, the data were analyzed by using 19 SPSS software and paired samples t-test.Results: The comparison between the two groups showed areas of flap survival on the seventh day of the stem cell group 10.592 ± 1.095 and in the control group 5.793 ± 2.023 and on the fourteenth day respectively 10.769 ± 0.934 and 5.519 ± 2.107, the difference was significant (P<0.001). Results angiogenesis stem cell group 27.666 ± 10.201 and control 12.750 ± 6.810 and the difference in the two groups was significant (P<0.001), so that the average of the group is more stem cells.Conclusions: These findings suggest that adipose-derived stem cells have the potential to improve the survival of random flap. This mechanism can also differentiate these cells into endothelial cells or indirectly by increasing angiogenesis is.

Introduction & Objective: Cardiovascular diseases are the main cause of death and disability in the world and Major psychological problems that typically affect people's Sufferers lives Include stress, anxiety, concern of the future and depression. One of the factors that affect mental health disease and how to cope with the disease. One of the factors that affect on patients mental health and how to cope with the disease, is the Perceptions of the disease and its consequences.Materials & Methods: A number of 194 cardiovascular patients attending Subspecialty heart clinics in Tehran hospitals during the period from July 2016 to March 2017 and had a history of open heart surgery were selected by convenience sampling. To Gathering the Data was used from the personal information and demographic questionnaires and illness Perception Questionnaire and stress, anxiety and depression Questionnaire (DASS-21). Data were analyzed using software SPSS 23 and Speraman correlation.Results: The correlation coefficient between illness perception and depression among the heart patients is r=0.27 and the correlation coefficient between the illness perception and anxiety in heart patients is r=0.42. So whit the %99 confidence the null hypothesis is rejected and it is concluded that the perception of cardiovascular disease and depression and anxiety there is a significant positive relationship (P<0.01).Conclusions: If the perception of patients with cardiovascular disease accompanied with Bias, it causes that they show more anxiety and depression but if their conception of illness Based on the reliable information by the doctor and truly understand the disease and its complications, their depression and anxiety is reduced.

Introduction & Objective: Chronic and fissure is a benign lightly prevalent condition which present with pain f hemorrhage during defecation at first, we try to use conservative treatment for all the patient, If they don' t cure, they can be done by open sphinctrotomy of and dilatation technique. In this study we compare the complication and outcome open sphincterotomy and dilatation.Materials & Methods: In this clinical trial study, 41 patients under went and dilatation and dilatation and 40 patients under went open spincterotomy. The hospital admission, duration of surgery, post-operative pain, and hemorrhage, late complication, recurrence and the return to habitual work were compared between them and dilation and open sphincterotomy.Results: The average time of surgery of and dilatation and open sphincterotomy were 38.2 ± 0.55 and 1.1± 0.38 minutes respectively. The difference was statically significant (P<0.001). The duration of hospital admission was 2.7± 0.45 and 1.1 ± 0.35 days after and dilatation & open sphincterotomy respectively.Conclusions: The outcome both group almost was the same but the operation time and the beginning time and dilation was better than the sphincter. So and dilation seems a suitable alternative open sphincterotomy.

Introduction & Objective: Coronary artery bypass graft surgery is the most effective strategy in selected patients with coronary artery disease that improves clinical outcomes. Due to increasing trend toward this intervention, determining the risk factors and rate of operative mortality among these patients seem vital.Materials & Methods: This descriptive study was conducted at Dr Heshmat Hospital from 2011 to 2014.By using the SPSS statistical software and Chi square, mann whitney, Fisher and logistic regression tests data were analyzed and risk factors for post coronary artery bypass grafting surgery mortality were evaluated.Results: Data from 2295 patients were collected. The operative mortality rate was 1.5%. Patient age, serum creatinine, valvular disease, prolonged intensive care unit duration, cardiopulmonary bypass time, had the strongest association with mortality (P=0.0001).Conclusions: Our mortality rate was comparable to that reported in other countries. Identification of these factors in the perioperative setting may enhance resource utilization and improve mortality following cardiac surgery.

Introduction & Objective: Altmetrics studies could be done through the databases contents of LinkedIn, Research Gate, Mendeley, Academia, uLike, and Impact Story. Since indexed documents’printing in citation centers and then receiving them is time taking and in some spheres it takes years for a document to receive a citation, Scientometrics studies are time-dependent. Actually, time-dependency is less in Altmetrics and the performance and effectiveness of both researchers and their papers could be investigated based on this factor.Materials & Methods: This is a Survey method that has been done through Altmetrics and with the help of Scientometrics. Firstly, data gathering has been done with the use of ISI database about researchers of surgery sphere. Subsequently, it has been investigated through analytical engine and then, the number of authors and documents have been gathered. After that, the name of researchers along with their official IDs in Research Gate have been investigated and some factors like the number of documents, the Reads, fulltext papers, the Followers, the Followings, and gathered data have been mined and with the help of SPSS software version 20, they have been analyzed.Results: Findings show that among the studied cases which are 327 out of 2062 in ISI, more than 86% could be fined in Research Gate. Other findings show that there is a significant relationship between the publications in Research Gate and the number of citations. Also other findings show that researchers whom papers are put in Research Gate could receive more citations. Some findings show there is a significant relationship between being in Research Gate scientific network and the number of citations in ISI. Besides, there is a significant relationship between the number researchers’ citations and the number of the Followers and the Followings. All in all, it offers that due to the findings of this study researchers from all spheres be in Research Gate scientific network so that in addition to scientific cooperation, could heighten the number of scientific citations of our country.Conclusions: Conclusions show that a low percent of researchers (nearly 14%) are not a member Research Gate. These researchers should be aware that these kinds of networks have been formulated to accelerate the scientific relationships between people, creation process, and dissemination of knowledge.Reasons like asking for help from other researchers, hidden and obvious sharing of knowledge, the increase of research interests, job opportunities awareness, and groups’ possibility of discussions could be the notions to researchers’ preferences to the use of social medias.

Chylothorax, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition, metabolic disorder and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. In this case report beside review of literature we present the case of a person with chylothorax that incidentally found to have diffused thoracic lymphangiomatosis.

Meckel’s Diverticulum is a congenital anomaly of gastrointestinal tract that it can become symptomatic. Bowel obstruction due to Meckel`s Diverticulum is one of the complications that is common under 18 years but it is rare in adult age. In this case the patient is 58 year old man who presented with obstructive symptom and in exploratory laparatomy had been revealed a large sized Meckel diverticulum that adhesive to abdominal wall due to fibrotic band and adjacent ileum loops had been twisted. For the patient diverticulectomy and enteroraphy has been performed.

In the past decades due to improvement of imaging and scanning modalities and awareness of women about carcinoma of the breast; the incidence of mastectomies has decreased¸ but there are many who for some reason do not refer to their physician in time¸ and they need mastectomy for optimal treatment since their disease is advanced.In modified radical mastectomy and axillary dissection due to extensive surgery¸ and large skin flaps there would be a lot of dead - space under the flaps and the movement and contracture of underlying muscles postpones the healing process¸ and helps seroma formation which this could lead to wound infection. Because of the very high rate of complication after mastectomies compared to clean surgical cases. The recommended vertical vinculum sutures can alleviate the wide dead - space or break it into small compartments and decrease surgical complications for smooth recovery and optimal scar formation.