Iranian Journal of Surgery
Year:2012 | Volume:20 | Issue:1|Papers Count:11

Sirenomelia, the Mermaid syndrome is an extremely rare and lethal congenital anomaly with an incidence of one in 60.000 to 100.000 pregnancies. It is characterized by complete fusion of the lower limbs associated with external genitalia absence, renal agenesis and anorectal defects. Sirenomelia represents the most severe of caudal regression syndrome. Although prenatal diagnosis has been reported even as early as the first trimester, we present an infant delivered from a 19 - year- old primigravida at 33 week's gestation, with a dysmorphic lower limb, agenesis of external urogenital and anorectol atresia. X- Ray (baby gram) and autopsy revealed other anomalies in the infant.The early detection of this syndrome during the first or the second trimester, helps us in the diagnosis of this rare anomaly and in terminating the pregnancy in a less traumatic period.

Introduction & Objective: Hypertension is dangerous and relatively frequent risk factors in gestational periods. Studies have shown that central lipid precipitation is a cause of hypertension, insulin resistance and increased in plasma lipids. Waist circumference is a way for evaluating of lipid in abdomen and whole body in non-pregnant women and it has a close relationship with Body Mass Index (BMI). The aim of this study is the evaluation of relationship between waist circumference and preeclampsia and its diagnostic value in predicting preeclampsia.Materials & Methods: This was a cohort and prospective study on 800 pregnant women with singleton fetus and gestational age less than 16 weeks. Waist circumference, blood pressure, maternal age, gestational age on the basis of sonographic result and previous hypertension were recorded in first visit. Then these women were evaluated every three month for hypertension, until their delivery. Finally, the data were analyzed by SPSS software and descriptive and deductive tests.Results: 25 cases (2.7%) of pregnancy related hypertension were recorded. There was no significant relationship between waist circumference and gestational age in 6-16 weeks of pregnancy, but there was a meaningful relationship between BMI and waist circumference at the time of admission. BMI and waist circumference were cleary higher in women with pregnancy related hypertension.Conclusions: Our study shows that waist circumference can be used as a facility means of predicting the risk of preeclampsia and pregnancy related hypertension. Informing women to decrease their weight before pregnancy has special importance.

Introduction & Objective: Today, the use of information technology (IT) has had positive impact on health systems, especially in the field of disease control, diagnosis, patient management and education. But despite the various developed applications of IT in all aspects of clinical and increase confidence and efficiency, this technology is not yet fully penetrate in medical and treatment field and there are many challenges and obstacles in accepting and applying it. Accordingly, this study examined challenges of IT applications in hospitals affiliated with Shaheed Beheshti University of Medical Sciences.Materials & Methods: Current research is descriptive-applied. Data were collected using two structured questionnaires and by viewing systems and documents and interviewing with managers of IT in 5 teaching hospitals. Compiled data were examined by SPSS software by using descriptive statistics.Results: Based on findings, from 14 areas of IT applications, all hospitals have electronic medical records but not fully formed, 3 hospitals have picture archiving system, 2 hospitals have community based health information networks, and answering phone and only one of them has e-complaints system, Physician-Hospital data network and data processing service.All IT managers noted advancing in computer technology as a stimulating factor and medical processes, business processes and economic factors as obstacles in applying IT in their hospitals. Also, 4 hospitals noted, the professional structure, and 3 hospitals noted the human factors as stimulating factors in the acceptance and use of IT.Conclusions: Based on the results, fields and the capabilities of applying IT, areas of influence and the obstacles facing the development of IT from professionals and senior information managers' view were identified. Thus, the factors influencing the policy making of these hospitals in IT applications was specified factors which can provide grounds for use of the efficient hospital resources, and thus cause cost reduction and downsizing care of services and therefore can create new employment opportunities for health care workers.Also, in prioritizing the macro-level budget in Ministry of Health, it can be considered as a basis for investment in hospital IT policies.

Introduction & Objective: There are high levels of depression and anxiety among medical students in comparison with the general population. We designed this study to determine the effect of some stresses on the mental health of medical students.Materials & Methods: An analytic descriptive study was performed on 320 medical students, 190 interns and 130 stagers in Islamic Azad University, Tehran Medical Branch during February 2010. Students filled an anonymous questionnaire that included demographic and stressors items and a 28-item General Health Questionnaire (GHQ-28).Results: Using GHQ-28 questionnaire, we found that the prevalence of psychological distress between medical students was 43.3%. There was a significant relationship between age, marital status, level of education, residence, the number of home mates with mental health. But gender, having children, and educational status doesn't have any significant relationship with mental health. Although problem in communication, economical and educational problems, interest in medicine, medical future opportunities and recreational activities are the most important stressors that have a drastic effect on medical student's mental health. But there was no significant relationship between having a major stress in the last 6 months and the mental health.Conclusions: As the prevalence of psychiatric disorders in medical students is about twice the general population, so it seems that the reduction of the mentioned stressors that increase anxiety and depression in medical students, could have an impressive effect on medical student's mental health.

Introduction & Objective: Buerger's diseases are an acute inflammation and thrombosis of arteries and veins of the hands and the feet. It is strongly associated with use of tobacco products. Buerger's patients are mostly young males (below40-45 years old) who are a heavy cigarette smokers. More recently, however, a higher percentage of woman and people over the age of 50 have been recognized to have this disease.Buerger's disease is most common in the Orient, Southeast Asia, India and the Middle East, but appears to be rare among African-Americans. People prefer to use light or ultra light cigarettes rather than full flavor cigarette because they think those products are less harmful. In this study, we have attempted in this study to assess the relation of buerger's disease with the kind of tobacco product usage.Materials & Methods: In this retrospective study we evaluated 100 patients with buerger's disease, in a period of one year at Shohada Tajrish hospital and Talaghani hospital. Because of underlying associated diseases five patients were excluded from our study. Data of these patients were gathered by through a direct questioning of the patients.Results: We evaluated 95 patients in this project. The mean age of the patients was 42 years (26-75/years). Mean duration of smoking was 21±0.2 years (6- 57/years). Last smoked cigarette in 29 persons was light or ultra light, 31 persons smoked full flavor and filtered Iranian cigarette, 21 persons smoked full flavor and filtered foreign cigarette, and 13 persons used non-filtered Iranian cigarette. The mean duration of usage of last cigarette brand before the onset of buerger's disease was 2±0.2 years.Conclusions: The results of our study show that contrary to what is thought in our society light and ultra light cigarettes have the same detrimental effects on human health, including buerger's disease, as full flavor cigarettes. Further research is needed for a more precise comparison of the effect of light and ultra-light cigarettes with and ordinary ones, available in the country, as far as leading to buerger's disease is concerned.

Introduction & Objective: Vascular access is a crucial step for performing the hemodialysis. Routinely, any patient undergoing hemodialysis should operate for native Arteriovenous Fistula (AVF). The aim of this study was to determine maturation time of the AVF and its relationship with underlying diseases.Materials & Methods: In a prospective cross-sectional study 87 patients with AVF were evaluated. The side of AVF was Antecubital in all cases. The time between AVF operation and the opening of hemodialysis was considered as maturation time. The relationship between maturation times and Diabetes mellitus, hypertension, dyslipidemia, history of coronary artery disease (CAD) and renal failure causes were evaluated.Results: 26 patients (29.9%) were female and 61 (70.1%) were male. The mean maturation time was 5.6±2.4 weeks. The mean maturation time in Diabetic and non-Diabetic patients was 6.1±2.4 and 4.9±2.2 weeks, respectively (P=0.016), in CAD and non-CAD patients were 6.8±2.5 and 5.1±2.1 weeks, respectively (P=0.001) and in the groups with middle arterial pressure<110 mmHg and>=110 mmHg were 6.1±2.4 and 3.6±0.8 weeks, respectively (P=0.001). The correlation coefficient between the maturation time and age was 0.453 (P<0.001) which was meaningful. There was no significant relationship between the maturation time and the gender, history of heparin usage at the time of operation. The central vein catheterization and the history of hemodialysis.Conclusions: Our studies showed that the patient's age and underlying diseases such as blood pressure, diabetes mellitus and CAD may affect the maturation time of AVF. That might be helpful if it is taken into consideration before prospective hemodialysis planning.

Introduction & Objective: The pulmonary diseases which are the most common diseases are categorized into two groups of Non Neoplastic and Neoplastic diseases. Non neoplastic diseases are tuberculosis, pulmonary fibrosis, inflammatory lung diseases, vasculitis and pneumoconiosis. Neoplastic diseases are Bronchogenic carcinoma such as squamous cell carcinoma (SCC), adenocarcinoma (AC) and lung metastatic lesions. With high prevalence and similarity of clinical signs, histopathology is helpful in diagnosis of diseases. The aim of this study is evaluation of frequency of clinical and pathological findings in lung diseases in Shahid Sadoughi University.Materials & Methods: This study was descriptive and retrospective and it involved 400 lung samples (200 samples Non Neoplastic lesions and 200 samles of Neoplastic lesions) who referred to Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals of Yazd, Iran, in the time interval 2001-2006. The information including diagnosis by biopsy, age, sex, clinical signs and diagnosis before biopsy, were filled out and data was analyzed by chi-square.Results: From 400 cases 273 were males (68.3%) and 127 females (31.7%), From 200 of Non Neoplastic lesions, TB was 39.9%, pneumoconiosis 27%, pulmonary fibrosis 23%, Vasculitis 6%, inflammatory lung diseases was 5% and of 200 Neoplastic lesions, primary lung Neoplastic lesions was 56.5% and lung metastatic lesions 12.5%. All lesions were more common in men than women and more common in ages over 60 years (except for vasculitis). The most clinical features were cough and dyspenica (except for vasculitis).The most common type of Neoplastic lesions were SCC (22.5%) and AC (23.5%).Conclusions: 1- All lesions were more common in men.2- All lesions were more common in age more than 60 years except for vasculitis.3- Cough and dyspenica were the most clinical findings.4- The most common type of Neoplastic lesions were SCC (22.5%) and AC.

Introduction & Objective: It seems that the frequency of substance abuse among hospitalized burn injury patients has been increased. However, few studies have investigated substance abuse among burned patients. The aim of this study is defining the incidence of substance abuse in burn injury patients, using the "Drug Abuse Screening Test" (DAST 20).Materials & Methods: Initially, we determined the validity of DAST 20 in spring 2010. Subsequently, this descriptive cross sectional study was performed on 203 burn injury patients who fitted the study's inclusion criteria. During the study, we gathered demographic data, burn features and DAST20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software (SPSS, Chicago, Inc).Results: According to the DAST20 results, 33% of the patients were in the user group. The mean score of DAST20 was significantly higher among users than it was among nonusers, and this difference was meaningful (P=0.000). The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol, which was meaningfully higher.Conclusions: This study showed that the prevalence of substances abuse in burn patients is high and DAST20 is a valid screening measure for studies on these patients.