Iranian Journal of Surgery
Year:2007 | Volume:15 | Issue:3|Papers Count:18

Introduction & Objective: Occupational injuries are still one of the main reasons of disability among industrial workers. According to surveys, more than 15 million accidents happen daily all over the world. The magnitude of the problem is well known in most developed countries but in developing countries less attention has been paid to this growing public health problem.Materials & Methods: This cross sectional study was conducted between 2002 - 2005 in three hospitals in Tehran - Iran. The process of data collection was conducted by using check lists and questionnaires.Results: The results have shown that adult group age between16 to 25 comprised 43% of patients and 78% of patients were under 35 years old.The most reason of accidents was insufficient safety of machines (42%). Forty-five percent of accidents were happened in morning shift .The majority of injuries occurred in summer. There was no difference between experienced workers and simple workers. Press machines and metal casters were the first line of making danger (25%).There was no significant difference between left dominant or right dominate hand patients in the side of trauma injury.Conclusions: These results show the need to implement prevention programs in industry sectors to reduce the prevalence of upper extremity injury. Another important point is the major role of safety educations for worker before employment.

Introduction & Objective: Lumbar disc herniation is one of the most common causes of low back pain. Lumber disc herniation is multifactorial disorder that occupational factors have the most important role.High weight lifting has direct association with lumbar disc herniation. The purpose of this study is the evaluation of correlation between occupational risk factors with disc lumbar disc herniation.Materials & Methods: In a case - control study we studied the occupational risk factors in patients with lumbar disc herniation admitted in neurosurgery ward of Emam Khomeini hospital. The information was collected from patient records. The patients of control group were selected from patients of other wards preferably from urology ward who has not the lumbar disc herniation.Results: There was no significant difference between means of age, weight, height and body mass index (BMI) of case and control groups (P-value: 0.830, 0.770, 0.796 and 0.548). Means of lifting weight (P=0.0001) and workload in case group was significantly higher than control group (P=0.0001).Conclusions: Disc herniation is associated with several factors. Present study reveals that mean of lifting weight and workload was significantly higher in patients with disc herniation than patients of control group.These results reveal that the kind of occupation is an effective factor in incidence of lumbar disc herniation.

Introduction & Objective: For all trauma patients during civil or war injuries, colorectal injuries is one of the most common challenging issues, which trauma surgeon may be encountered.Materials & Methods: In this review article we discuss the main aspects and management of colorectal traumatic perforation. About 56 articles have been reviewed and different trials have been discussed.Colostomy versus primary repair for colon perforation, management of extraperitoneal and intraperitoneal rectal perforation are discussed, also antibiotic therapy and time of colostomy closure which are controversial has been discussed in this article.Results: Some recent papers, have considered primary repair as a suitable method except in the patients with destructive colon wound and in the presence of risk factors.These risk factors accompany with the increase of mortality and morbidity rate, but do not influence the anastomosis leakage. This factors include, shock, time interval between the injury and surgical intervention, simultaneous injury to other organs, the need to blood transfusion and other disabling diseases.Conclusions: To clarify some other aspects of colorectal trauma surgery, trials and research in ambiguous subjects is recommended.

Introduction & Objective: Limb length discrepancy is a common medical problem. There are different radiological methods, rather than clinical methods, each with its own advantages and disadvantages.Materials & Methods: In this study, the patients with the clinical diagnosis of limb length discrepancy were included. At first, they were evaluated clinically and the amount of true limb length discrepancy was detected. Then the results of scanogram were compared with the clinical results.Results: Therefore, 161 patients were included in this study, 97 patients (60%) were male and 64 patients (40%) were female. After the first examination, in 6.1 % of patients the apparent length of two limbs were the same, but in 53.4% of patients the right limb and in 40.5% of patients, the left limb was shorter. With scanogram evaluation, in 56.6% of patients the right limb and in 43.4% of patients the left limb, was shorter.In 22.2% of patients there was no correlation among the side of the short limb and the results of scanogram and clinical examination.Conclusions: This study shows the significance of scanogram in assessment of orthopedic examination and measurement of exact shortness of the limb before any corrective or lengthening procedures.

Introduction & Objective: Comparing accident trauma in different countries, Iranian people have a high rate of this kind of trauma. In this kind of trauma, head and neck trauma has a significant rate.Materials & Methods: This descriptive analytical study assesses the cause, type, incidence, demographic character of maxillofacial fractures, managed at our medical center during a 2-year period and compares them with the existing body of literature on the subject.A 2-year retrospective clinical and epidemiologic study evaluated 159 patients treated for maxillofacial fractures from 1995 to 1996 at one medical center.Results: There were 138 (87%) male patients and 21 (13%) female patients. The patients ranged in age from 3 to 83 years, with 52.8% (84 patients) in the 20 to 39 year age group. A number of parameters, including age, gender, cause of injury, site of injury, and type of injury were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Appropriate consultant specialists treated other concomitant bodily injuries. There were 138 (86.8%) mandibular and 21 (13.2%) maxillary fractures. Car accidents caused 123 (77.4%), falling 28 (17.6%), and quarrel 8(5%) of the maxillofacial injuries. Regarding the distribution of mandibular fractures, 30.4% were seen in the condylar region, 17.39% in the symphyseal-parasymphyseal region, 15.22% in the angle region, 25.36% in the body, 7.97% in the ramus, and 3.62% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 24 (37.5%), Le Fort I in II (17.19%), Le Fort III in 8 (12.5%), and alveolar in 1 (1.56%) patients.Conclusions: The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from one country to another.

A seven-year-old child sustained a severe avulsion injury to the left mandible leaving a 6 cm gap. An orthopedic pin alone was used for immobilization and stabilization. Radiographs of the mandible 2.5 years later showed complete osteogenesis and solid bone formation over the pin. The young age of the patient was definitely important in influencing this favorable result. The author’s experience in other non-traumatic patients using the same procedure has shown such bone formation. The source of osteogenesis is believed to be from mesenchymal cells of the soft tissue remaining in the gap. The theories pertaining to the source and mode of osteogenesis in this case are discussed.

Introduction & Objective: Congenital scoliosis is among the most challenging deformities for treatment and even more is the presence of underlying cord anomalies. The result will be catastrophic if we can not predict underlying cord anomalies prior to surgery. The goal of this study is to find the clues to this puzzle.Materials & Methods: For 381 registered patients with congenital scoliosis, physical exam, plane xray, and intra-canal imaging (MRI or myelography) were done to assess the possible underlying anomalies.Then correlation of cord anomaly with other anomalies in other part of body was considered in SPSS software and Paired t-test.Results: Cord anomalies was seen in 83 patients (21.8%) and neurologic deficit found in physical exam in 26 patients (6.8%). Abnormal neurologic findings correlated with cord anomaly (P-value = 0.0001). Skin mark (hair patch, dimple, nevi, etc) had positive correlation with cord anomaly (P-value = 0.001). Type III congenital scoliosis had positive correlation with cord anomaly (P-value = 0.01).Conclusions: It is suggested to be careful with neurologic deficit in physical exam, skin mark and type III congenital scoliosis when preparing the patients for surgical treatment of scoliosis. We should remember that normal physical examination does not rule out cord anomaly.

Introduction & Objective: After cardiac surgery, pericardial effusion occurs in up to 80% of cases, it is maximized in size at 10th days after operation. Then after it gradually reduces in size. Tamponad occurred in 1% of these patients. The goal of this study is to reduce the incidence of pericardial effusion after CABG and decreasing mortality and morbidity with posterior pericardiotomy.Materials & Methods: This study was performed in 319 patients undergoing coronary bypass grafting in Shariati Hospital between April 1998 and March 1999. Pericardial effusion in two groups (patients with posterior pericardiotomy or without posterior pericardiotomy) were analyzed and evaluated in these patients.Results: In 31.6% of the patients on the 7th postoperative day, pleural effusion was seen. Posterior pericardiotomy significantly reduced pericardial effusion 7th postoperative days (7.4% in patients with posterior pericardiotomy group and 48.1% in patients without posterior pericardiotomy group (with P-value=0.0001). Posterior pericardiotomy affected and reduced pericardial effusion. Pericardial drainage (pericardial window) only was needed for patients without posterior pericardiotomy (in 4 cases or in 2.5%) (With P-value 0.048).Conclusions: This study shows the better outcome of posterior pericardiotomy. In patients undergoing CABG, if either of the pleural spaces is opened, we recommend posterior pericardiotomy be performed for them.

Introduction & Objective: Spinal epidural abscess (SEA) is an infective and devastating disease of spinal canal that needs the prompt clinical diagnosis and treatment. Delay in appropriate intervention will result to irreversible nervous complications. In this article with introduction of two patients, we try to choose an optimal approach with minimal manipulation and least destruction to prevent the instability and to achieve best results. Two cases will be introduced. The first one is a 17-year-old girl with progressive quadriparesis and diagnosis of extensive epidural abscess from cervical to lumbar region and the second case, who was a 38-year-old man with abscess from thoracic to lumbar region. Two cases were operated with minimal manipulation and prevented of postoperative instability, was prevented. Inspite of rapid progression and irreversible complication of SEA, good result and prevention of complication and instability can be obtained with choice of restrict surgical procedure and minimal invasion.

Introduction & Objective: Aortocoronary saphenous vein bypass grafting relieves anginal pain in patients with coronary artery disease. However, its effectiveness is limited due to graft failure; the 10-year patency rate is 50%-60%.Materials & Methods: This article with reviewing of 80 different papers focuses on the pathophysiologic aspects of this widespread, costly, and disabling disease, with emphasis on late graft occlusion and distinctions between arterial and venous atherosclerosis in terms of histology, pathophysiology, and risk factors.Results: Early, 1-year, and late graft failure may be due to thrombosis, fibrointimal hyperplasia, and atherosclerosis, respectively. There is general agreement that vein graft atherosclerosis differs from arterial lesions in terms of temporal and histological changes. Vein graft atherosclerosis is more rapid, with diffuse concentric changes and a less noticeable fibrous cap, making venous plaques more vulnerable to rupture and subsequent thrombus formation.Conclusions: Despite progress in understanding the pathophysiology, some aspects of vein graft atherosclerosis need to be clarified. As new research and clinical experience broadens our knowledge of the pathogenesis and pathophysiology of vein graft atherosclerosis, it will not seen farfetched to introduce novel treatment options against this widespread, costly and disabling disease.

Introduction & Objective: Total rate of mortality due to breast cancer has been remained almost constant in contrast of increasing rate of breast cancer incidence. This shows improvement in early diagnosis of this disease. After clinical examination, mammography and sonography are the best early diagnostic methods of breast cancer. The aim of this study was to compare sonography results and findings of clinical examinations and mammography.Materials & Methods: In this study, all women engaging in Markazi province university of medical sciences were underwent breast clinical examination in this study and mammography, sonography and needle or tissue biopsy were accomplished for them if there was any indications. Collected data were analyzed by EPI test in SPSS software.Results: The number of 979 cases with age range of 20 to 45 years old was examined. The incidence of breast cancer was obtained 0.03%.Sensitivity and specificity indexes of sonography with 95% confidence interval as compared with clinical examination were reported 25.8% and 71.9%, and as compared with mammography were reported 5.0% and 7.1%.Conclusions: Sonography in breast lesions, with higher possibility of being found in clinical examinations, is a better diagnostic method than lesions with more specificity of mammography. So, mammography could not been replaced by sonography, although sonography is more acceptable for patients.

Introduction & Objective: The object of this study was to determine the relationship between outcome (assessed by Glasgow Outcome Scale) and recurrence in chronic subdural haematoma (CSDH).Materials & Methods: Eighty-two consecutive patients who underwent surgery for CSDH were included in this study.Results: The relationship between the following variables and CSDH recurrence was studied: sex; age; history of trauma; Glasgow Coma Scale (GCS) at the time of admission (stage 1: GCS>12, stage 2: GCS: 8-12, stage 3: GCS<8); interval between head injury (when a history of trauma was present) and surgery; presence of a midline shift on CT scans; presence of intracranial air 7 days after surgery; haematoma density; haematoma width; presence of brain atrophy; and Glasgow Outcome Scale (GOS, both quantitative and nonquantitative) at the time of discharge. Throughout the analysis, P<0.05 was considered statistically significant.The results showed lower GCS (P<0.001), higher GOS (P<0.001), presence of intracranial air 7 days after surgery (P=0.002), and a high density haematoma (P<0.001) were significantly associated with recurrence of CSDH.Conclusions: It was concluded that GOS is related with recurrence in CSDH.

Introduction & Objective: Intestinal malrotation is typically presented during the first few months of life but may sometimes appear later in life, causing difficulties and mistakes in diagnosis. The clinical diagnosis of malrotation is especially difficult in older children and adults because the presentation is usually nonspecific and the suspicion is rarely considered. In these cases diagnosis is often delayed.Materials & Methods: We reviewed records of patients with intestinal malrotation in Tehran Children’s Medical Center from 1983 to 2003. Records of 11 patients who were admitted after infancy and had undergone surgical procedure, which proved intestinal malrotation, were analyzed. Clinical and paraclinical data and surgical findings for each patient were collected. Frequent symptoms, duration of previous symptoms, associated anomalies, delay in diagnosis, previous wrong diagnoses, duration of admission time before surgery, surgical findings, complication and outcome were collected.Results: Frequent symptoms were bilious vomiting (100%), recurrent abdominal pain (54%) and constipation (45%). Other symptoms and clinical findings were dehydration, abdominal distention, fever, weight loss, obstipation and diarrhea. Five of eleven patients had had symptoms from neonatal period and median age of first presenting symptom was 30 days. The average interval between first symptoms and surgical correction of malrotation was about 22 months. Mean interval from admission to surgery was 7.3 day.Twenty two differential diagnoses had been considered for these patients and some of them had undergone false treatment. Contrast studies (upper gastrointestinal series and barium enema) diagnosed malrotation more accurately. None of our five patients that evaluated with ultrasonography were diagnosed by this modality.Conclusions: The diagnosis of intestinal malrotation should be considered in children and adult patient with signs and symptoms of small-bowel obstruction and chronic abdominal pain and in all similar patients with vague abdominal discomfort who do not respond to other therapies. Ultrasound examination can be a screening test but in centers with less experience, it is necessary to do contrast studies (including upper GI series and barium enema) to rule out malrotation in suspected patients.

Introduction & Objective: Breast cancer is the major cause of death in 40-44 years old females and is the most common site specific cancer in them. The incidence of breast cancer is 1 of 8 female person. Some of prognostic factors are tumor size, pathologic grade, auxillary lymph nodes, ER, PR, P53 and HER-2-neu that are effective in prognosis and therapeutic plan. Frequency and relationship of the last four markers with each other and with menopause and age are discussed in this article.Materials & Methods: Two hundred female patients with pathology documented ductal or lobular breast cancer were studied in a 3 years period by IHC method for ER, PR, P53 and HER-2-neu.Results: All the patients were female with the mean age of 49.6 years (SD=+11.36) and the range of 26 to 81 years old.ER was positive in 142 cases (71%), PR was positive in 131 cases (65.5%), P53 was positive in 63 cases (31.5%), and HER-2-neu was positive in 143 cases (71.5%).There was a significant positive correlation between ER and PR (P<0.05). There was a significant negative correlation between P53 and ER or PR. There was a significant positive correlation only between ER and age. There were not any correlations between each marker and menopause.Conclusion: HER-2-neu indicates the worst prognosis and better response to chemotherapy. There was a significant difference of HER-2-neu in the reference texts (25%-37%) and this research (71.5%), which may be caused by genetic differences.

Introduction & Objective: Transurethral resection of prostate (TURP) is the most popular procedure for benign prostate hyperplasia (BPH). Several different irrigation solutions have been proposed for this procedure, but some controversies exists in their selection. This study aimed to compare sterile water with 1.5% glycine as irrigation solution for transurethral resection of prostate.Materials & Methods: In this clinical trial all patients who were candidates for TURP were randomly assigned into two groups based on irrigation solution of procedure, sterile water group and 1.5% glycine group. Pre- and postoperative clinical and paracinical data was gathered and analysised by SPSS 11.5 for Windows software package, using t-test and chi-square tests. P-values less than 0.05 considered statistically significant.Results: The number of 80 patients was assigned randomly to receive strile water and glycin (each group had 40 patients). Patients age, weight of resected prostate and total volume of irrigation solution was not significantly different between two groups. Post-operative serum sodium, potassium, urea and creatinin levels decreased significantly in both groups; but there were no difference between groups in respect to these parameters. The Post-operative decline of hematocrit and hemoglobin in glycine group was significantly greater than water group (-4.22±4.24% v.s -1.3±4.25% and -1.47±1.96 mg/dl v.s -0.46±1.6 mg/dl, respectively). Twenty four patients among all studied cases (30%), developed signs and symptoms including nausea, vomiting, headache, dyspnea, tachypnea and blood pressure rise. There was no significant difference in the rate of development of these problems between two groups. TUR syndrome requiring medical intervention, developed in only 2 patients (2.5%) which one of them was in glycine and the other was in water group. Both of these patients recovered completely following conventional medical measures.Conclusions: In this study there was no difference in alterations of sodium, potassium, urea, creatinine and development of TUR syndrome between two groups and post-operative decline of hematocrit and hemoglobin levels in water group was significantly milder. Thus, utilization of water as a cheap and available irrigation solution can be suggested in groups of patients.

Introduction & Objective: Breast pain is a common disorder affecting up to 70% of women during their life. Although most of these women can be managed by reassurance alone, a significant number still require medical treatment.Topical Non - Steroidal Anti Inflammatory Drugs (NSAIDs) are established as having a palliative effect on mastalgia.Materials & Methods: A clinical trial study of Piroxicam gel versus Diclofenac gel was carried out, over a period of one year. Fifty female patients attending the outpaint department with severe breast pain were given one of the two agents alternatively, after selection.Results: The results show that out of 25 patients treated with diclofenac gel, 60% had a clinically significant response after two months of treatment, compared with, 92% with Pyroxicam gel. Only one patient (4%) had side effect with Diclofenac gel.Conclusions: Piroxicam gel application is more effective, safe and acceptable treatment compared with disolfenac gel for sever cyclic mastalgia.