Iranian Journal of Surgery
Year:2009 | Volume:17 | Issue:3|Papers Count:14

Objectives and Backgrounds: Brain tumor, both being and malignant are progressive neurodegenerative disease and has a direct effect on the patient’s cognitive, neurological and psychic functions. They cause focal cerebral dysfunction at the site of the tumor lesion. Studies focusing on psychiatric symptoms in brain tumor have been mainly descriptive and the numbers of cases in studied populations have been small. The purpose of this review article is to define psychiatric symptoms in relation to tumor characteristics and its location among patients with brain tumors.Materials and Methods: Among the papers written between 1985 to 2008 about mental disorders, we chose 114 papers and the extracted data from 55 papers are summarized in this review article.Results: Psychiatric symptoms can be the first and only signs of primary brain tumor and between 1-2% of patients with a psychiatric disorder may have unrecognized brain neoplasm. The factors suggested to be associated with psychiatric symptoms among brain tumor patients are tumor location, patient’s premorbid psychiatric status, tumor-associated cognitive symptoms and adaptive or maladaptive response to stress.Conclusion: Since patients with brain tumors have multiple somatic and psychic symptoms, collaboration between units of neurosurgery, radiology, anesthesiology, neurology, oncology and psychiatry is inevitable in its diagnostics and therapy.

Introduction & Objective: Bilateral neck exploration is the good standard for parathyroid adenoma localization in primary hyperparathyroidism. But not all of surgeon have the necessary experience for accurate surgical exploration. But there are new methods for surgery like unilateral exploration and minimally invasive surgery. Thus, preoperative localization could reduce time and stress of surgery.Materials & Methods: In a prospective study 80 patients with documented primary hyperparathyroidism through raised serum calcium and parathyroid hormone (PTH), the results of sonographic localization were compared with the findings of surgery and 99mTechnetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients whom adenoma had been localized or not localized through sonography or Sestamibi scan with student’s t-test.Results: In a prospective diagnostic tests accuracy study, 80 patients with primary hyperparathyroidism enrolled. Sonography detected enlarged parathyroid glands in 61 of 80 patients (76.3%), with sensitivity of 83.5% and positive predictive value (PPV) of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients (78.8%) with sensitivity of 85% and PPV of 91.3%. There was no significant deference between sonography and scintigraphy in localization of adenomas. When both sonography and scintigraphy were used for localization, they located 73 adenomas (91.3%), with sensitivity of 97.3% and PPV of 93.5%.Conclusions: Sonography is an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, and overall it is comparable with sestamibi scintigraphy. This study suggests a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test gives negative result.

Introduction & Objective: Delirium is an acute mental state, characterized by disturbed consciousness and cognitive dysfunction occurring in the setting of a physiological derangement, caused by a medical disorder. Cognitive decline after cardiopulmonary bypass (CPB) surgery, especially in the elderly patients, is of significant concern, since the advent of CPB procedures. Most prospective neuropsychological studies also found postoperative cognitive decline, early after surgery. Nowadays the incidence of postoperative delirium is more than 90% in some reports. Recently, the rate of cardiac surgeries has risen in the aged population, and the social and economic impacts of these complications have increased. We are about to evaluate the relationship between the incidence of delirium after heart surgery and some of the intraoperative factors.Materials & Methods: During 6 months in a university-affiliated hospital, 250 patients of over 50 years old, who were elected for CABG surgery, enrolled in the study. All patients were examined preoperatively and in the second and seventh postoperative days as well; with a comprehensive neuropsychological and neuropsychiatry assessment; (mini-mental-state examination). DSM-IV was also used to confirm the diagnosis.Results: In this study, the incidence of delirium after open heart surgery was 47%. This study indicates that delirium after heart surgery is associated with CPB time>120 minutes, cross-clamp time>75 minutes, intraoperative HTC<30% and intraoperative temperature<30oC. There was no relationship between EuroScore and Delirium.Conclusions: Although the origin of the postoperative neuropsychological alterations is unclear, the present data suggests an association between some factors and postoperative delirium, and its knowledge can help us to prevent or cure this complication. Yet, a continuous investigation for the prevention of postoperative Delirium incidence and its treatment is essential.

Introduction & Objective: Temporomandibular joint (TMJ) ankylosis can lead to the restriction of mouth opening, poor mouth cavity hygiene, dental abscess and face deformity. Despite several researches concerning the TMJ arthroplasty techniques, there are controversies about the best surgical technique in TMJ ankylosis repair. In this study, we report the comparison of three surgical techniques - Costo Chondral Graft (CCG), Temporal Fascia Graft and Silicon Prosthesis Graft - in TMJ arthroplasty.Materials & Methods: In 10-year duration (1997-2007), thirty four patients with TMJ ankylosis were admitted in Fatima Hospital, and they all were included in this study. They were operated with Inter positional Gap Arthroplasty. Ten patients were operated with CCG surgical techniques, 10 patients with Silicon Prosthesis Graft and 14 patients with Temporal Fascia Graft. Results of these surgical techniques were compared after at least 7-month post operation follow up.Results: In this study, the most frequent cause of TMJ ankylosis was trauma (52.9%). 19 patients had bilateral surgical operations that resulted in 12 unsuccessful (63.2%) and 7 successful cases (36.8%). Overall, 29 patients used post operation physiotherapy and that resulted in 12 unsuccessful (41.4%) and 17 successful cases (58.6%).Conclusions: In TMJ arthroplasty, unilateral surgical operations were significantly more successful (P=0.03), whereas the results in these three surgical operation techniques were the same. In addition, the use of post operation physiotherapy did not show significant statistical differences in the results.

Introduction & Objective: Nowadays, trauma is the fourth cause of mortality and morbidity in developed countries. The major cause of these mortalities was intra-abdominal hemorrhage due to blunt abdominal trauma. Therefore, any action taken for helping quicker diagnosis of intra-abdominal hemorrhage could save the lives of patients more effectively.Materials & Methods: This analytical cross-sectional study concerns the patients with abdominal blunt trauma admitted to the emergency section of Khatam al Anbia hospital during 2006-2007. Information from sonography and CT scan registered in the questionnaire were analyzed with statistical software SPSS 14.We used sensitivity, specifity, positive predictive value, negative predictive value and accuracy as statistical tools for comparison.Results: From 100 patients surveyed, 20% were female and 80% male. The most common clinical symptoms in the both groups were abdominal pain and then abdominal tenderness. Between different clinical symptoms, from the point view of existing abdominal free fluid and CT-scan report, we received significant differentiation (P=0.017). Sensitivity, specificity, negative and positive predictive value of sonography in diagnosis of abdominal free fluid were 84%, 86%, 91% and 75% respectively and in the diagnosis of Intra abdominal damage were 54%, 90%, 65% and 79% respectively.Conclusions: Sonography has sensitivity, specificity and enough accuracy for surveying abdominal free fluid in blunt abdominal trauma in comparison with CT-Scan in children and adults age group, and if combined with abdominal viscera parenchymal abnormalities, these parameters would go sensitively up in children's age group.

Introduction & Objective: One of the earliest signs of Buerger's disease is cold sensitivity and increased pain with cold. In this study, we evaluated cold sensitivity and seasonal variation of Buerger's disease in patients admitted to Shohada hospital during 2001-2008.Materials & Methods: In this Descriptive study of the patients with Buerger's disease who were admitted to Shohada Hospital, 205 patients were selected sequentially. All the information was extracted using medical records.Results: The mean age of patients was 45.96±13.08 years old. Among them 96.1% were male and 92.7% active smoker. Season of initiation of first signs of Buerger's disease, were 39.5% in winter, 30.2% autumn, 17.6% in spring and 12.7% in summer. At first presentation, 82.9% had ischemic ulcerations, 13.7% had gangrene and 32.2% had surgical amputation.Conclusions: Most of our patients showed the first signs of Buerger's disease in the seasons of winter and autumn. These patients had cold sensitivity and increased pain with cold. It seems that, smoking cessation, medication therapy and sympathectomy results in decreasing the symptoms and signs of the reffered referral patients.

Introduction & Objective: Staphylococcus Aureus (SA) is one of the most prevalent bacterial pathogens in human beings. Approximately 20% of healthy persons are persistent carriers and 60% are intermittent carriers of SA. Nasal cavity is one of the important sites of its colonization. The aim of this study was the study of the frequency of staphylococcus areus nasal carriers in the surgical staff of Hamadan Educational Hospitals, and it's antimicrobial susceptibility pattern.Materials & Methods: In a case-control study, 246 persons (123 persons from surgical staff of Hamadan Educational Hospitals and 123 persons from the healthy personnel of Hamadan University) entered in our study. A nasal soap was prepared from each patient for SA isolation and its antibiotical susceptibility were determined with antibiogram. Data were analyzed with the SPSS.Results: 17 persons (13.8%) of the study group and 14 persons (11.4%) of the control group had positive cultures for SA. There was no meaningful statistical difference in SA prevalence (P: 0.351). In the study group, there was no meaningful statistical difference between SA prevalence with ward, occupation and occupation time (p>0.05). In both groups all cases were resistant to penicillin and were sensitive to Vancomycin. In the case group all subjects were resistant to Clindamycin. In control group all subjects were senstive to cephazolin and cotrimoxazole. 59.2% of the cases and 35.7% of the controls were MRSA.Conclusions: Although in present the study the prevalence rate of nasal carriers of staphylococcus aureus was higher in medical personnel than healthy people, but the difference is not statistically significant.In this study, the number of carriers of medical personnel is less than reports from other countries.

Introduction & Objective: Nausea and vomiting in early pregnancy are common symptoms which are a great burden either economically or psychologically on the pregnant women and her family. Considering the fact that, pregnant women do not seek appropriate medical treatment because of their concern of drug's side effects on fetus; it would be useful to administrate vitamins, which are accepted as safe drugs, for the first line treatment. Our Purpose was to determine the effectiveness of Pyridoxine for nausea and vomiting of pregnant women with less than 16 weeks of gestational age.Materials & Methods: During the winter of 2006, 70 pregnant women with less than 16 weeks of gestational age, who had attended a private clinic and four urban Health Centers in Rasht, were randomly divided in to two groups to receive either oral Pyridoxine 40 mg per day or placebo during five days, in a double- blind fashion. Patients graded the severity of their nausea by a visual analog scale over 24 hours before the treatment and then during the five days of treatment. They also recorded the number of vomiting episodes over the previous 24 hours before the treatment and during the five days of treatment. Data was analyzed by t-test, ANCOVA, ordered logistic regression, chi-square, Mann-Witney and Wilkoxon tests.Results: There was a significant decrease in the mean of post therapy minus baseline nausea score in the pyridoxine group compared with that in the placebo group (P=0.019 - ANCOVA). There was also a greater reduction in the mean number of vomiting episodes in the pyridoxine group (P=0.042 - Mann witney test).Conclusions: Pyridoxine is effective in decreasing nausea and vomiting in early pregnancy and it can be administrated 40 mg per day during 3 to 4 days.

Introduction & Objective: Urethrorectal fistula (URF) is a rare occurrence, usually following surgery or another intervention for prostatic disease, penetrating trauma, pelvic fracture and inflammatory bowel disease. Spontaneous closure is rarely successful and reconstructive procedures are usually performed. We reviewed retrospectively the medical records of 8 patients who underwent URF repair between March 1995 and September 2005.Materials & Methods: Fistulaes were repaired in 3 patients due to penetrating trauma (gun shot injury, perineal surgery for bladder stone) using York Mason, in 3 patients due to pelvic fracture urethral distraction defeat using Transabdominal Transpubic with omental flap and in 2 patients due to pelvic radiation, using Transperineal with gracilis flap techniques. Diverting colostomy was performed before reconstructive surgery.One patient had failed transanal fistula repair before admission to our center, and the other 7 patients had undergone long term unsuccessful conservative management.Results: Overall, 5 of 8 patients with URF were repaired successfully using the York Mason and Transperineal with gracilis flap techniques. Three patients with URF who underwent Transabdominal Transpubic with omental flap repair had urethral stricture and recurrence of fistula. They were managed by stage urethroplasty and a perineal skin flap was placed on the fistula. After the completion of reconstructive surgery, none of patients had urinary or fecal incontinence, but 3 patients who were repaired by Transabominal Transpubic approach were suffering from erectile dysfunction.Conclusions: York Mason technique has excellent results for URF with low morbidity, specially for small iatrogenic fistula with healthy margin and without scar or infection. In large fistulas due to previous radiotherapy with in appropriate tissue transperineal repair with gracilis interposition has good results.

Introduction & Objective: In this article, we use Bibliometric methods to review and compare 10 years of scientific productivity of Iranian surgeon community in the ISI database.Materials & Methods: The data of this study has been collected from three sub databases of the ISI database. These 3 sub databases are, Science Citation Index (SCI), Social Science Citation Index (SSCI), and Art and Humanities Citation Index (A and HCI). Entering the keyword of SERGERY in topic search of ISI database, the retrieved items were analyzed by the analysis engine of the database, and then the data were further analyzed by the EXCEL software.Results: Our findings showed that 67% of the scientific productivity of Iranian surgeon community has been produced by 10 Iranian universities. In this regard, Tehran University of medical sciences researchers has authored 126 documents which constitute 17.1% of all productions. In second rank is Shiraz University of medical sciences that has produced 81 documents, which consists of 11% of all productions. The most international cooperation of the Iranian surgical researchers has been with the researchers of USA i.e. 59 articles have been co-authored with the help of USA surgery researchers. Concerning journals publishing the research of the Iranian surgeon community, the journal of Translations Proceedings, has published 276 documents, which constitutes 37.3% of all productions in this realm. Our findings also show that topics of Transplantation, Immunology and Clinical Neurology have had the lead in publications.Conclusions: Our search showed that the scientific productivity of Iranian surgeons has been ascending in these years. This study includes the publications which have appeared in the ISI journals. The other researches in this regard have not been covered in this article. Thus, Iranian Surgeons have had more publication activity than those which have appeared in the ISI data base. For better understanding of Iranian surgeon's research activity, it is suggested to have a research in the other databases than that of ISI database.

Hydatid cyst is an endemic disease in many parts of the world including our country. It is significant from the viewpoint of public health, political and economic and migration considerations. It can involve any part of human body. In this study we report a case of primary isolated hydatid cyst of omentum which is an unusual location for this disease. To the best of our knowledge this is the first case of primary isolated omental hydatid cyst in Iran. A similar case has been reported in the literature.Due to endemic occurance of hydaid disease in Iran, we review the literature in terms of unusual location of the disease, hoping to strengthen our knowledge about this disease.

Teratomas are germ cell tumors of a nonseminomatous type. Whereas most teratomas occur in the ovaries and testes of adolescents, they can be found in midline structures such as sacrococcygeum (congenitally), anterior mediastinum, retroperitoneum, and the pineal gland. Primary retroperitoneal teratomas are extremely rare in adults. We meanwhile describe the latest report of mature retroperitoneum teratoma, introduce the case of an 18-year-old man with 20×20 Cm abdominal mass that undergone surgery. Histopathological examination revealed a mature teratoma.