Iranian Journal of Surgery
Year:2020 | Volume:28 | Issue:1-2|Papers Count:12

Acute anemia is a common occurrence in burn patients. Most of these patients need to receive blood transfusion during acute burn care. Blood transfusion may cause serious complications. It is essential to consider an optimum threshold for blood transfusion in sever burn patients to reduce complications without side effects on outcome measurements. Some randomized clinical trials have been done to compare liberal blood transfusion strategy (9g/dL to10g/dL) with restrictive blood transfusion strategy (7g/dL to 8g/dL) in recent years. Based on the data of these trials, usage of restrictive blood transfusion strategy compare to liberal blood transfusion strategy in sever burn patients did not increase the mortality rate، blood stream infection, duration of hospital and ICU stay. A restrictive transfusion policy also reduced the number of blood transfusions and as a result caused a reduction in transfusion-associated complications and costs.

Introduction & Objective: The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy. Materials & Methods: Between 2009 and 2010, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracic surgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chest wall using a 7. 5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleural slide. Results: In the upper thoracic wall, ultrasonography demonstrated a sensitivity of 63. 0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive value of 50. 0%, and an overall accuracy of 65. 0%. And for lower thoracic wall, ultrasonography demonstrated a sensitivity of 81. 0%, a specificity of 59. 0%, a negative predictive value of 89. 0%, a positive predictive value of 44. 0%, and an overall accuracy of 65. 0%. Conclusions: Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. Use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Introduction & Objective: Thousands of people undergo cosmetic surgery every year, and the popularity of this type of surgery has grown significantly in recent years. Emotional intelligence may play a role in the demand for cosmetic surgery. Therefore, this study aimed to investigate the validity and reliability of Golman's emotional intelligence questionnaire in patients referring to the beauty clinic. By improving this questionnaire appropriate to the target community, it is possible to understand the relationship between emotional intelligence and the desire to perform cosmetic surgery. Materials & Methods: The present descriptive-analytical study was performed on 700 applicants for cosmetic surgery referred to Hazrat Fatemeh Medical Center in Tehran in 1397. After completing the Golman Emotional Intelligence questionnaire by the samples, the reliability of the questionnaire was assessed by Cronbach's alpha and its validity was investigated using confirmatory factor analysis using diagonal weighted least square method. The R3. 6. 3 software and a lavaan package were used for statistical analysis. Results: The goodness of fit of confirmatory factor analysis model was unacceptable and 9 questions did not significantly explain the variance of emotional intelligence questionnaire components. After removing those 9 questions, the goodness of fit of the model was improved and the reliability of the whole questionnaire increased from 0. 84 to 0. 87. Conclusions: Some questions did not explain the variance of the components, which either had to be corrected or removed from the questionnaire. Using an improper tool can have misleading results. Therefore, it is recommended to use the modified Golman Emotional Intelligence Questionnaire, which is standardized in the target population.

Introduction & Objective: Treatment of constipation includes education of child and parents, dietary changes, medication, psychotherapy, behavioral therapy, and eventually surgery. This study is the success rate of surgical treatment in children with chronic idiopathic constipation refractory to routine medical treatment. Materials & Methods: The sample consisted of 16 patients, 8 girls and 8 boys, of all children with chronic idiopathic constipation refractory to medical therapy, who were referred to a tertiary center for final surgical plan. The study was descriptive. Data were entered into statistical software spss-18. For data analysis, multiple regression analysis and multivariate analysis of variance was used. Results: A total of 16 patients were enrolled, half female, and half of the patients were male, mean age was 3. 96 ± 2. 29 years. The results showed that in 13(81. 25%) patients after surgery, the patient's symptoms completely resolved. In 14(87. 5%) patients, the use of laxatives was reduced to one time per day except in 1(6. 25%) patient, who requiring the use of laxatives. In all patients, frequency of bowel movements increased. Multiple regression analysis showed that age, sex, duration of disease and age less than 5 years have direct significant relationship (P < 0. 05) with successful surgical treatment. Conclusions: Our results show that surgical treatment in refractory chronic functional Constipation which did not respond to medical treatment, leads to better control of disease, increase frequency of defecation, decrease need to laxative and relieving soiling.

Introduction & Objective: Infertility can affect women's health, so spiritual and mental health might be very important in case of infertile women. Therefore, the goal of this study was to investigate the relationship between spiritual well-being, anxiety, depression and emotion in infertile women after assisted reproductive surgical technology. Materials & Methods: The present study is a descriptive-analytic research which was conducted on a cross-sectional basis. The statistical population of the study consisted of infertile women who referred to hospitals in Shiraz, among whom 247 subjects participated in the study. Paloutzian and Ellison’ s Questionnaire of Spiritual Well-Being questionnaire, Beck anxiety& depression Questionnaire and the Garnefski Cognitive Emotion Regulation Questionnaire were used. Data was analyzed using descriptive statistics methodology including mean (standard deviation) and frequency (percentage) in the form of tables, charts, and Spearman Correlation Tests. The SPSS software version 23 was used at 5% P-value. Results: The results of this study showed that anxiety, depression and some aspects of Garnefsky's emotion were negatively correlated with spiritual well-being. In other words, the higher the spiritual health of the infertile woman, the greater the ability to adapt and accept the problem of infertility and to accept assisted reproductive surgical technology and also uses her or others' blame mechanisms to a lesser extent. Conclusion and discussion: Spiritual well-being might help improving the mental status of infertile women and reduce their negative emotions. This spiritual well-being might guarantee the ability to cope with infertility-related complications and assisted reproductive surgical technologies. Conclusions: Mental health can help improve the mental state of infertile women and reduce their negative emotions, and in the light of this spiritual health, the ability to adapt to infertility-related problems and infertility surgery can be guaranteed.

Introduction & Objective: The tendency for beauty has been prevalent for centuries. The emphasis of social culture on female beauty has gradually led to concerns and caring more about looks and appearance; the individuals of different ages undergo cosmetic surgery, incur high financial costs, and tolerate unpleasant physical and psychological consequences. Thus, this study aimed to determine the motivations of women and girls to undergo cosmetic surgery. Materials & Methods: The present research was interpretive phenomenological study. The study population included girls and women who underwent cosmetic surgery in Zanjan. Using purposive and snowball sampling methods, fifteen individuals were selected as sample. The semi-structured interviews were conducted with them. The qualitative data were collected, recorded, coded, and classified into main themes and sub-themes. Finally, the Colaizzi method was used to analyze the data. Results: The findings showed that the intrapersonal factors including negative body self-concept, social anxiety, striving for superiority, low self-confidence, fear of aging, and aesthetic assessment of body, the family factors including spouse satisfaction and fear of being compared to beautiful women, and the social factors including social pressure, class identity, media advertising, role modeling of friends, group compliance, and fashionism were the respondents' motivations to undergo cosmetic surgery. Conclusions: Based on the findings, it is recommended that women and girls be evaluated psychologically before cosmetic surgery and undergo educational-therapeutic interventions in order to improve their self-confidence, reduce their negative self-concept, social anxiety, and fear of aging, improve their interpersonal and marital relationships, and change their attitudes and beliefs to overlook media influence, social pressures, and fashionism.

Introduction & Objective: In contemporary societies, because of high emphasis on beauty, attention to physical appearance especially in women has taken to extremes; accordingly, hundreds to thousands of people voluntarily undergo cosmetic surgery. Tendency to cosmetic surgery in women can be affected by various psychological variables and also affect them simultaneously. As such, psychological state of the applicants or their emotional state before surgery has become an important issue in the field of psychology. This study aimed to evaluate causal relationship between perceived social support and positive, negative affect in women applying for cosmetic surgery and also examine the mediating role of core self-evaluations. Materials & Methods: This study was a descriptive correlational study. The statistical population included women applying for cosmetic surgery referred to Hazrat Fatemeh Hospital in Tehran during the first six months of 1398. Two hundred women who referred to cosmetic surgery centers in Tehran were selected via convenient sampling method. The Positive and Negative Affect Schedule (PANAS) (Watson, Clark, & Tellegen, 1988), perceived social support (Zimet et al., 1988), and Core self-evaluations (Judge, 1997) were used to collect the data. Then, the data was analyzed by path analysis in LISREL software. Results: Direct effect of perceived social support on core self-evaluations was significant only in the light of self-esteem (β = 0. 27), generalized self-efficacy (β = 0. 24) and locus of control (β = 0. 22) (P <0. 01), but not in neuroticism (β = 0. 05). Furthermore, self-esteem had a direct effect on positive (β = 0. 46, P < 0. 01), but not negative affect (β = 0. 14). General self-efficacy also had a direct effect on positive (β = 0. 31) and negative (β =-0. 23) affect (P < 0. 01). Locus of control had a direct effect only on women's negative affect (β =-0. 19, P < 0. 05), and neuroticism directly affected both positive (β =-0. 37) and negative (β =-0. 62) affects (P < 0. 01). Perceived social support had an indirect effect on positive (β = 0. 25) and negative (β =-0. 17) affect mediating by core self-evaluations (P < 0. 01). Conclusions: Due to the significant indirect effects, the findings indicate the important mediating role of core self-evaluations. Receiving social support can lead to the activation of core self-evaluations and then reduce negative affect and improve positive affect. This is especially important for women who intend to undergone a cosmetic surgery.

Diagnosis and surveillance of angiogram-negative subarachnoid hemorrhage (SAH) has been a controversy in neurosurgical literature. A combination of computed tomography angiogram and digital subtraction angiography has been suggested as follow up studies in guidelines. SAH with a spinal pathology is a rare diagnosis, which is challenging under common symptomatology of SAH, such as loss of consciousness. Here, we report an angiogram-negative SAH, who discharged following recovery. In follow-up, he underwent emergent surgery with hemiparesis and the final diagnosis was thoracic cord hemangioblastoma.

Surgical adhesives including new biomaterials still have lot of progress. A good tissue adhesive should have in addition to excellent performance, acceptable clinical properties. Medical adhesives are classified in to soft tissues adhesives, hard tissues adhesives, drug delivery adhesives and bio adhesives. Viscoelastic properties determine the ability to wetting the adhesive and its concentration on the skin. Soft tissue adhesives are divided in to groups of skin and internal organ adhesives. The internal organ adhesives include cyanoacrylates and fibrin. Fibrin and cyanoacrylates adhesives are the most common adhesives of the internal organs. The fibrin adhesives imitate the final stage of the blood coagulation mechanism and include two main components of fibrinogen and thrombin. Significant properties of cyanoacrylates adhesives include the need for a catalyst, high polymerization rate and strong bonding creation. Cyanoacrylates adhesives also have the microbal barrier capability. An ideal medical cyanoacrylate adhesive should have a long chain, suitable toughness and biocompatibility. The commercial/medical cyanoacrylates adhesives are DERMOBOND and INDERMIL. This article introduces the mechanism of action and latest advancements in the field of surgical adhesives for internal tissues.

Although medical cure diseases is one of the necessities of social life, the legislator has in some cases considered the physician to be responsible for damages that occur to the patient during treatment. In order to facilitate treating and to prevent being liability a barrier to treatment, the legislator has considered the conditions in which the physician is not liable for damages resulting from treatment. Some treatments, although necessary for the patient, are considered maltreatment by the physician in failing to comply with technical or legal requirements, and may result in patient hurt. In Iranian law, the physician, in accordance with general rules of responsibility, is liable to compensate the patient for damages if she fails to receive proper treatment. However there are situations where the physician is not responsible even she does not adhere to the rules or standards for treatment and even she has malpractice. The purpose of this study is to examine the legal requirements for physician's exemption from liability for medical malpractice. According to its results, the physician is not responsible if the practice was legitimate, there was consent for treatment, lack of fault and obtaining an acquittal.