Iranian Journal of Surgery
Year:2019 | Volume:27 | Issue:2|Papers Count:11

Spinal and epidural anesthesia are commonly used in various types of surgery. Their safety is confirmed, however, sometimes serious complications seems to be related to these procedures. Postural puncture headache is the most common side effect, which usually changes when patients change position and recovers spontaneously. However, headache following Dura Puncture can also be an early sign of a subdural hematoma formation and it should be considered as a risk factor. Failure to respond to proven medical treatments as well as changes in the patterns of headache, along with other neurologic symptoms, the patient should be suspected of subdural hematoma. it is a rare but fatal complication with neurologic deficits, if not diagnosed early.

Introduction & Objective: Glioma is a kind of CNS tumor, originated from glial cells. CNS diseases can present with Sensory-Motor, Cognitive or psychological dysfunctions. Dysfunction in sensory-motor domain can be measured with standard physical examination and Para clinics, but evaluating dysfunction in cognitive and psychological domains are usually more complicated. Materials & Methods: 30 patients with dominant hemisphere gliomas, operated in Sina hospital were assessed in this study. They were undergone cognitive examination with Addenbrooke’ s Cognitive Examination (ACE) pre operatively, post operatively and 3 and6 months after surgery. Results: Before Surgery, mean cognitive function mark before surgery was 74. 2± 16. 78. Just post operatively mean cognitive function mark slightly dropped to 64. 17± 18. 2 but this drop wasn’ t statistically meaningful. 3 months after surgery, patients’ cognitive function got better and reached 74± 16. 61 and 6 months after surgery, mean cognitive function mark in patients, reached 82. 76± 12. 9. This improvement at 6 months after surgery in comparison to just post-operative status was statistically significant. Conclusions: In pre-operative assessment, 83. 3% of patients have some degrees of cognitive dysfunction. This makes cognitive dysfunction, a significant sign of gliomas. Although post operatively we observed a slight decline in cognitive function, but in 6 months, most patients significantly recovered.

Introduction & Objective: In most cases, peritoneal adhesions are caused by abdominal surgery and is one of the most important surgical complications and causes of mortality and morbidity. These adhesions frequently cause major complications such as chronic abdominal and pelvic pain, obstruction and ileus of the small bowel, abdominal abscess, infertility in women, and prolongation of surgeries subsequent organ damage. Various methods and materials have been introduced to reduce or prevent these adhesions. One of these materials is Oxiplex-AP absorbable anti-adhesion gel, which has not been used for intra-peritoneal surgery in humans. The aim of this study was to evaluate the effect of Oxiplex / AP gel on reducing postoperative adhesions in rats. Materials & Methods: This experimental study was performed on 40 rats. The rats were randomly divided into 4 groups of 10 each. In the first group, during laparotomy, we used simple repair with Lambert sutures at the site of small bowel desertion. In the second group, in addition to Lambert suture repair, we used absorbable anti-adhesion gel at the site of injury. In the third group, small bowel desertion was left without repair and no gel in the abdomen. In the fourth group, the intestines left in the abdomen after applying the gel at the site of injury. Results: In this study, 40 rats divided in four groups. Peritoneal adhesions in all four groups were evaluated two weeks after primary surgery based on Nair criteria. The results of all four groups showed that the third adhesion type (severe) had the highest (10 cases) in the first group and the lowest (5 cases) in the fourth group. This study showed that there is significant statistics difference between treatment groups (P value = 0. 05). This difference was significant between the first and fourth groups and also between the first and third groups. Conclusions: In this study, the effect of Oxiplex / AP absorbable gel was investigated which was statistically significant. The obtained data showed decreasing in the amount of adhesion in the fourth group (using absorbable anti-adhesion gel without suture) compared to the other groups and in the third group (without suture and non-gel application) comparing with the first group (suture repair) showed a decrease in adhesion. It can be claimed that this gel can decrease adhesions due to deserosation and also it can be agreed that in the absence of this gel, deserosation of less than one-third of the diameter of the intestine should be left untreated in the abdomen, which results in less adhesion than Lambert sutures without increasing the chance of intestinal perforation.

Introduction & Objective: CAH and Cloaca are challenging malformations with various surgical techniques in the treatment, including the old Passerine technique and the new TUM technique, which we need to improve our knowledge of the long-term outcomes of patients with rare malformations, and recording of post operative complications will improve the surgical development of the surgical procedure. The aim of this study was to investigate the functional and cosmetic effects and complications of both TUM and Passerine vaginoplasty methods. Materials & Methods: A cohort study in female patients with two malformation Cloaca and CAH in the last 15 years that was carried out at the Tehran Bahrami Pediatric Hospital with two techniques of Passerine and TUM and with referring to patient records, clinical examinations and patient records, clinical examinations and Preoperative cystoscopy examination a post-operative under anesthetic examination, patients' information and complications including urinary incontinence and vaginal stenosis and inappropriate position of vaginal insertion and urethro-vaginal fistula were recorded. Results: 41 patients with an average age of 10. 86 years at the time of the study were included in two groups of 20 patients with the old technique (flap) and 21 with a new technique (TUM) in the study. All patients were female. Of the 41 patients, 23 Patients (56. 1%) had CAH, and 18 patients (43. 9%) had cloaca. The length of the common channel was 2. 5 cm in both groups and the mean age of the flap group was 3. 7 years and the TUM group was 5. 54 years. The mean follow-up of the flap group was 10 years and the TUM was 2. 8 years, and the duration of the flap surgery was 3. 37 hours TUM is 2. 1 hours and the duration of hospitalization is 3. 4 days for flap and TUM for 2. 2 days. There is a 2. 1 significant difference between the three variables of the follow up and the time of operation and the duration of hospitalization between the two techniques with P = 0. 001. In two of the complications, vaginal stenosis and inappropriate vaginal position were significantly different between the two groups, with P = 0. 001 and P = 0. 007 respectively. Conclusions: The findings of the present study indicate that TUM surgery is better in the results and the beauty and proper position of the vagina compared to the passerin method. Less frequent and faster hospital discharge and shorter duration of surgery, with a better appearance and more beauty in the TUM surgery, is one of the characteristics that the findings of this study support.

Introduction & Objective: As the accumulation of fluid in the pleural cavity is a common finding in patients with cancer, its diagnosis deserves careful consideration., The aim of this study was compare two methods of thoracoscopy and acupuncture needle biopsy in the diagnosis of malignant pleural effusion in patients. Materials & Methods: In a cross-sectional study, 50 patients with pleural effusion, suspected to have malignant pleural effusion, who referred to Shahid Beheshti Hospital (Qom) during the 3 years (2011 to 2014), were selected through available sampling Was performed. Results: A total of 50 patients with pleural pleural effusion, suspected to have malignant pleural effusion, were included in the study, which included 21 males and 29 females with 14 patients in the age group less than 50 years old and 36 subjects in the age group > 50 years. Thoracoscopic medication had a sensitivity of 86%, 100%, positive predictive value of 100%, and a negative predictive value of 77%. The susceptibility of 53%, 100%, 100% positive predictive value and negative predictive value of 66% and diagnostic accuracy were obtained from the needle closure biopsy method. Conclusions: Considering the high sensitivity of the thoracoscopic medical technique to the pleural biopsy, the similar complications in both methods, and the possibility of taking actions during thoracoscopic medication, thoracoscopy seems to be the first and the best after thoracentesis negative in patients Suspected of malignant pleural effusion. Although the cost of doing this is higher, due to the health plan, there is little cost to the patients and, on the other hand, with timely diagnosis, reduces the costs of readmission and the resulting problems.

Introduction & Objective: Osteoporosis is a hidden disease that has heavy burden to patient and society. The first step in managing chronic disease is documentation and properly register disease data. This study was conducted by the goal of identifying Data requirements and introducing a structured classification for osteoporosis progress note’ s dataset. Materials & Methods: This is a practical study that conducted in 2019. In this study, data elements were determined at first through the review of articles and studies, then through a questionnaire to the expert group. The results of questionnaires were analyzed by the Item Impact Index formula. Classification of data elements has been provided by studying methods of data classifications and then interviews with experts. Results: Osteoporosis progress note’ s data set was presented in 9 sections and 51 items. We use HOAP – one of the SOAP adaptations – as a reference framework classification of the dataset. Conclusions: Due to the importance of registering progress notes of osteoporosis and in order to structuring these reports to identify medical procedures during patient encounter, the data elements and the classification for that were provided and evaluated.

Introduction & Objective: Mounting development of tourism, specifically Health tourism (which is divided into preventive tourism, curative tourism, and aftercare tourism) as an important part of tourism industry is a key for development in many societies, especially developing countries. Materials & Methods: The current study concentrates on medical therapy as a branch of curative tourism. The main goal of the research is perusing determinants which attract tourists to come to Atieh and Parsian hospital in Tehran, with aim of undergoing a rhinoplasty. Results: Findings represent that the most important determinants for attraction of tourists to come to Iran consist of: privilege of Iran to perform rhinoplasty, appropriate services, availability of residence for tourists, tourists’ satisfaction of cost effectiveness, greater advantage of Iran in performing rhinoplasty due to tourists’ carriers, existence of a meaningful relation between age of the tourists and their satisfaction of cost effectiveness, services of hospitals and residential facilities. However, the cost doesn’ t have a meaningful correlation with attraction of tourists to have a rhinoplasty. Conclusions: Findings of this research indicate that Iran has enormous potential to attract international tourists in the field of rhinoplasty, and due to the privileges of Iran, along with existence of expert physicians in the country, we can expect great accomplishments in future.

Pseudoaneurysm is one of the most important entities after partial arterial injuries due to trauma or surgical interventions especially in areas close to the main arteries. This can be restricted or associated with significant complications. In this article, we report a case of ruptured popliteal artery pseudoaneurysm along with compartment syndrome and acute limb ischemia in a 47-year-old man who underwent surgery.

Maggot therapy is mentioned in holy books. After the introduction of antibiotics to the market, a long period of delay occurred in using maggot therapy method. In recent years, due to resistance of infectious agents against antibiotics, there has been a good return to this method. In 1999, WHO confirmed this science and included it in its remedial policies. Maggot therapy was approved by FDA in 2004. Tissue engineering means development and change in experimental growth of cells in tissues or limbs, in order to substitute or heal the damaged part of the body. The main problem of serious wounds is the risk of infection, their depths and loss of tissue. Integrated use of maggot therapy and tissues engineering is a bridge between two ancient and modern methods which is very effective for curing diabetic wounds and bedsore. Due to high probability of success in this method, development and use of the above-mentioned method is highly recommended and it is necessary to use this method in our country widely.