Iranian Journal of Surgery
Year:2014 | Volume:22 | Issue:2|Papers Count:16

Pouchitis is an inflammatory reaction occurring after ideal pouch anal anastomosis, which is a treatment of choice for patients who have medically refractory ulcerative colitis with dysplasia or cancer, and for patients with familial adenomatous polyposis. This operation allows continence, with typically 3 to 4 bowel movements per day. Pouchitis is an inflammatory reaction occurs in about 50% of patients. It is thought to be related to bacterial overgrowth and is treated with antibiotics, and probiotics may be protective. Most cases of pouchitis are readily controlled, but about 5 to 10% may prove refractory to all medical therapy. Alternative surgical procedures include a continent ileostomy or more often traditional ileostomy. The physical and emotional burdens imposed on the patient should be recognized, and care should be taken to see that the patient receives all necessary instructions and psychological support.

Introduction & Objective: The control of parenchymal hemorrhage especially in liver parenchyma, is still one of the challenges surgeons face saving the patients’ lives, despite progresses in surgical science. Furthermore there is a competition between the researchers in this field to introduce a more effective method. This study aimed at comparing the hemostatic effect of zinc chloride and aluminum chloride on controlling the bleeding from liver parenchymal tissue.Materials & Methods: In this animal model study, 60 male Wistar rats were used. A length of two cm and a depth of half a cm incision was made on each mouse’s liver and the hemostasis time was measured, using zinc chloride and aluminum chloride of different concentrations (15%, 25%, and 50%). Finally, the collected data were entered into SPSS software and analyzed using the one-way Anova test.Results: In all groups we had complete hemostasis. The hemostasis time of zinc chloride concentration groups was significantly less than that of the aluminum chloride group.Conclusions: Zinc chloride is more effective than aluminum chloride, as a hemostatic agent, in controlling liver hemorrhage, in our animal model study.

Introduction & Objective: Regeneration of skin tissue is important in the plastic and reconstructive surgery and random skin flap pattern is one of the most common procedures in plastic and reconstructive surgery. Necrosis of the skin flap is an inevitable complication after the surgery. Several factors such as ischemia, insufficient blood flow and venous concentration are causes in necrosis creation. Pharmacological agents and modifications of procedures have been proposed to avoid this complication. In this study, the effects of Angipars cream on skin random flap survival were examined in rats.Materials & Methods: Twenty male Sprague -Dawley rats were selected and randomly assigned to two equal groups. Surgery was done under general anesthesia and a rectangular 2×7 cm flap was generated on the back of each rat and it was sutured once again. Angipars cream was used on flap pedicel in control group and Vaseline was used in the other group for ten days. The mean and standard deviation was used to assess the test data and independent t-test was used to compare the groups.Results: During the study, one rat of the control group died. There were no cases of infection or hematoma. The necrosis rate of the angipars group was 28.86±6.43 percent and in the control group was 25.3±10.52 percent. There was no significant difference in necrosis rate between the two groups.Conclusions: Angipars cream has no effect on increasing perfusion of random flap. Furthermore, also increased angiogenesis was not observed in this study.

Introduction & Objective: Occlusion of one artery in the upper extremity in some cases results in severe hand ischemia, such as resting pain or gangrene and may lead to mild hand ischemia, such as hand claudication or fatigue. After radial artery harvest, revascularization of the artery can be useful, despite compensatory dilatation of ulnar artery.Materials & Methods: Fifteen patients who had one artery occluded in their upper extremity underwent operations and were revascularised with end to end anastomosis or vein graft or prosthetic graft, and the arteries were repaired with 8.0-10.0 prolen and evaluated for one year.Results: 14 patients, out of 15, whose upper extremity was perfused by repaired artery (93%) were open until 5 months; after 12 months, 13 repaired arteries were patent (86.6%) and 2 arteries were occluded (13.4%).Conclusions: Occlusion one of the main arteries in the upper extremity can be a problem for both patient and surgeon. In some patients, especially in musicians and labor, this can produce spasm of the finger and wrist. In these cases, recanalization of artery is mandatory.

Introduction & Objective: Trauma is the most common cause of death in persons aged 1-44 years and the third most common cause of death regardless of age. Abdominal trauma is one of the most prevalent cases of trauma. Laparatomy is a therapeutic method which is applied for abdominal trauma. The aim of this study is to evaluate the incidence and cause of penetrating and blunt abdominal traumas.Materials & Methods: This retrospective descriptive study was done on all patients who had undergone emergency laparatomy in at Shahid Beheshti hospital at Kashan for abdominal trauma during, the years 2009-2012.The data were collected through a questionnaire that was completed at the trauma center. The statistical analysis was performed using the SPSS 16.0. The statistical analysis was conducted using Fisher's exact test and chi-square.Results: Out of 166 trauma patients who had undergone laparotomy, 120 cases (72.3%) had blunt trauma and 46 (27.7%) had penetrating trauma. The largest number of patients were in the 2nd and third decade of their life, and 130 patients (80%) were male. Car accidents and stab wound were the common cause of blunt and penetrating abdominal traumas, respectively. Spleen was the common damage organs. There were 25 (54.3%) and 8 (10.8%) cases of negative laparotomy in the penetrating and blunt traumas respectively. The mortality rate was 7.2%.Conclusions: This study showed that blunt abdominal trauma is more common than penetrating abdominal trauma. Car accidents and stab wound are the most common causes of abdominal trauma. The mortality rate is higher in blunt trauma than penetrating trauma. Therefore, attempts of governmental organizations are needed to prevent and decrease car accidents and socio-cultural problems.

Introduction & Objective: Surgical therapy is still useful and preferred for patients with large third-degree or fourth-degree hemorrhoids. One of the novel methods in the surgical treatment of hemorrhoid is laser therapy. The aim of this study is to evaluate the outcome of closed hemorrhoidectomy versus laser therapy.Materials & Methods: In this study, 56 patients with internal hemorrhoids of grade III, who were admitted to the hospital, were divided randomly into two groups, each one containing 28 patients. The first group were treated by using laser hemorrhoidectomy and the other group underwent the Ferguson closed hemorrhoidectomy. Visual pain score and complications such as bleeding, urine retention, anal stricture, gas and fecal incontinence and infection were compared in the two groups. The data in questionnaire and forms were analyzed with SPSS software and descriptive statistics and if needed statistical tests of T-test and chi- square test was done, and if needed accurate Fisher test was used. A P-value of less than 0.05 was considered as statistical significance level.Results: There was no significant difference between age and sex in the two groups. Visual pain score in laser hemorrhoidectomy in the first 24 hours (1.42±1.57) and during the first week (0.49±0.39) was significantly less than the case of closed hemorrhoidectomy group (respectively 1.91±2.57 and 0.58±0.75). Except in the cases of bleeding, which was considered to be significantly lower in laser therapy than control group, the difference between the two groups was not significant as far as other complications is concerned. The two groups did not differ in duration of surgery. However, the cost of laser hemorrhoidectomy group was significantly higher (P<0.001).Conclusions: Despite higher costs, laser treated hemorrhoidectomy patients experienced less pain than the standard hemorrhoidectomy patients. So, we suggested laser therapy as the preferable method in treating hemorrhids.

Introduction & Objective: The best method for inguinal hernia repair is matter of debate. The knowledge of efficacy and complications of each method would help to make better decisions. Accordingly, in this study the outcomes and complications of Bassini and McVay methods, both involving mesh were compared in the repair of inguinal hernia.Materials & Methods: In this randomized clinical trial, 200 patients, who were candidates for the repair of inguinal hernia, were selected and by using block randomization method were assigned to undergo either McVay method with prolene mesh (6 in 11 cm) or Bassini method with prolene mesh. The patients were followed up to 12 months for complications, recurrence, and early and late postoperative pain.Results: The frequency of complications was alike between the two groups (P>0.05). In Bassini and McVay groups 2.9% and one percent had recurrence, respectively, without significant difference (P>0.05). The mean duration for returning to job was 13.8 and 14.1 days in Bassini and Mcvay groups, respectively, without significant differences (P>0.05). The mean pain severity was 4.4 and 4.2 days in Bassini and McVay methods, respectively, without significant difference (P>0.05). In the one-year follow-up, the pain was seen in 34.2% and 10% in Bassini and McVay methods, respectively (P=0.001) which was a significant differences, but the severity of pain was similar (P>0.05) with its mean 2.1 and 1.9 in Bassini and McVay methods, respectively.Conclusions: Totally, according to the obtained results, it may be concluded that both McVay and Bassini methods, with mesh, had good efficacy and the recurrence, pain and complications were alike between the two groups and were at the acceptable level.

Introduction & Objective: Central venous catheter insertion may cause morbidities and sometimes mortalities. Traditional catheter insertion is done on the basis of superficial guides, a technique which is abolished in developed countries, while CVC insertion can be carried out under the sonographic guide at patient’s bedside with least complications.In this survey, we used sonographic guide as the procedure and gathered accurate information about the needed number of venous punctures, and investigated the injuries and complications in the neighborhood of vein during catheter insertion.Materials & Methods: During this case -control study, 213 patients underwent the CVC insertion, of which 105 patients underwent sonographic guide and the remaining 108 patients did not go through it. All the procedures were done under local anesthesia and by a single surgeon. The effects of sonographic intervention on reducing the complications, success of catheter insertion and injuries to the neighboring tissues were analyzed. The data regarding the complications, the success of the procedure and injury to the adjacent structures were analyzed. Kolmogorov-Smirnov and Levin’s tests were used for checking normality and homogeneity, respectively. Chi-square and Fisher’s exact tests were used as appropriated.Results: 129 males and 84 females, totally 213 patients, were enrolled in this clinical survey. In the sonographic group the rate of successful CVC insertion was 100 % (105 cases), and in the other one it was 88.95(90 cases). The number with more than one venous puncture was significantly higher in the non sonographic group compared to the sonographic one, 35.2% (38 cases) vs 11.4 % (12 cases). Arterial puncture happened in 20 cases in non sonographic group (18.5%), and in 2 cases in the other one (1.9%) with a meaningful statistical difference. In 9 cases of non sonographic group venous puncture was not achieved despite 3 times trial, they had it with the first sonographic procedure.Conclusions: Sonographic guidance in CVC insertion increases the rate of achievement, and of the same time reduce the number of punctures and injuries to the adjacent elements near the vein. So acquaintance with this procedure for CVC insertion (even as self-education) seems essential.

Hepatic artery aneurysm is the second most common visceral aneurysm and has been seen mainly in men. Most cases are asymptomatic and are discovered accidentally, but the incidence of this kind of aneurysm is high among ruptured visceral artery aneurysm. The most common causes of hepatic artery aneurysm is trauma, and atherosclerosis. This paper is a case report about the ruptured hepatic artery aneurysm in a 51 years old man without history of previous disease or trauma, who referred with abdominal pain. When he was diagnosed, ruptured hepatic artery aneurysm, he underwent an emergency laparatomy. Ultimately, his bleeding was controlled after two days, and the patient was discharged in good condition.

Bronchopulmonary carcinoid tumor is a relatively rare disease and like other rare conditions its optimal treatment is still in doubt. In this article we present a case of an atypical lung carcinoid tumor which had invaded the heart. The patient was treated with an en-bloc resection of the tumor and the resection of the affected portions of the left atrium through a left lateral thoracotomy along with cardiopulmonary bypass and cardiac arrest.

Iran is ranked sixth in the world in terms of natural disasters. The April 9, 2013 an earthquake with intensity greater than 6, on the Richter scale, shook the Dashti area of Bushehr, killing and injuring numerous people. No documented Report of clinical and demographic characteristics of this earthquake has been published yet in Iran. The information gathered from this report, is essential for proper planning for this operational management of the crisis caused by natural disasters.This is a retrospective study of the disaster in 2013. For this purpose, the Proceedings of hospital directory and patient data were evaluated and a questionnaire containing demographic information, initial examination, patient history, examination and treatment findings were extracted and collected. Using daily data and the Proceedings to extract and analyze the strengths and weaknesses of management of that disaster.Suggestions for the formation of operational teams and organizations responsible for supporting the victims through providing medical care, public assistance organizational, planning for tertiary prevention and rehabilitation of patients and maneuvering is made.

The whole of medicine depends on the transparent reporting of clinical trials. Trials with inadequate methods are associated with bias, especially exaggerated treatment effects. Better reporting of clinical trials is essential. Fortunately, consort statement is a very helpful instrument in this field. Consort check List contains a list of information items that must be included in randomized trial reporting. This check list is discussed under six sections, including: title and abstract, introduction, methods, results, discussion, and other information. Considering to the widely utilization of the consort statement by valid journals, it is essential that authors, reviewers and readers of internal journals get familiar with the provisions of this declaration, and understand how to correctly use this standardized reporting checklist for the clinical trials. The purpose of this paper is to introduce the consort statement and have some discussion about it.