Iranian Journal of Surgery
Year:2009 | Volume:17 | Issue:1|Papers Count:16

Introduction & Objective: The major challenge for a burn team is infection, which is known to cause over 50% of burn deaths. Burns become infected, because the environment at the site of the wound is ideal for the proliferation of infecting organisms. This study analyzes the distribution of bacterial infection of burn wounds through the tissue culture in patients hospitalized at the burn center of Bessat hospital of Hamadan it also studied the antibiotics resistance patterns of isolated bacteria.Materials & Methods: During a six months period, 82 patients were included in this study. Wound biopsy samples were collected days after admission to Burn ward in Bessat hospital. Isolation and identification of microorganisms was done using the standard procedure. Disk diffusion test was performed for antimicrobial susceptibility.Results: The mean age of the patients was 20 years (in the range, 1-63 years). The overall ratio of infections was 93.3%. There were fewer male patients (46.5%) than female patients. The microorganisms causing infections were Pseudomonas aeruginosa (72.7%), Staphylococcus aureus (14.4%), and Staphylococcus epidermis (7.8%). Among this pseudomonas aeruginosa was found to be over 90 per cent resistant to amikacin, gentamicin, tobramycin, Cefteriaxone, Cefotaxim, Ticracillin and Cefepime.Conclusions: High prevalence of nosocomial infection in patients hospitalized at the burn center of Bessat hospital of Hamadan and the detection of high levels of antibiotics resistance patterns of isolated bacteria suggest continuous surveillance of burn infections and the developing of strategies for antimicrobial resistance control and the treatment of infectious complications. A nosocomial infection surveillance system may be introduced to reduce the rate of nosocomial infections among burn patients, and for better therapeutic options.

Introduction & Objective: Clawing of toes of foot are usually seen in neuromuscular disorders, but in some instances, after trauma to leg ,which may be accompanied with fracture or not, after healing of fracture or soft tissue injuries, clawing deformity of foot may be appeared. We try to determine the cause of it and the most appropriate treatment for it.Materials & Methods: We studied 47 patients from1382 to1386. After getting patients approval, they enter our study. All of them were our original patients who were referred to emergency room of our hospital for their first trauma. 42 of them had fracture of leg but in 5 cases there were no fracture of leg. In the follow up visits of them, we clawing of their foot so we examine them for sensory and motor function and took radiography and electromyography (EMG) of their lower extremity. We did tenotomy of the flexors of their toes and removed callosities when it was necessary.Results: There were no sensory or motor deficit in their traumatized lower extremities and also there were no abnormality in their EMG. In their X rays, there were no obvious or huge callus mass. In the radiography of their foot, there were no fracture of foot bones and also no abnormality of their toes like malunion or destruction of small joints of their feet.Conclusions: We tried to rule out some causes of the clawing of foot .There were no checkrein effect of the fracture callus, and in EMG, there were no nerve injury nor any bony abnormality in X rays. They had only unilateral problem and their clawing began after trauma. So neuromuscular diseases could be ruled out. We think a fibrotic event after crush injury to calf muscles can produce this deformity.

Introduction & Objective: Transverse and midline abdominal incisions are both commonly used for elective major upper abdominal surgery. Both incisions have specific effects on abdominal wall function, leading to postoperative differences in clinical parameters such as pulmonary function, pain and wound healing. We conducted a prospective study to compare the effects of midline and transverse incision on pulmonary function.Materials & Methods: We studied 70 patients undergoing elective upper abdominal surgery in two groups: transverse group (35 patients) and midline group (35 patients). The parameters of forced vital capacity (FVC) forced. Expiratory volume in one second (FEV1) and the ratio of FEV1/FVC were measured in all patients before and after laparotomy by two spirometries. Finally the SPSS (version 13) was used for completing all the statistical analyses, and P< 0.05 was considered as significant.Results: The mean in all parameters decreased after laparatomy in both groups, but the decrease in midline incision was significantly higher than the case of transverse Incision (P<0.05).Conclusions: Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. Thus, this incision is the preferred for upper abdominal surgery.

Introduction & Objective: Hysterectomy is a high incidence operation and there are differences of opinion about sexual desires after hysterectomy in lectures. Incidence of sexual disorders after hysterectomy various from 10- 40 percent.Materials & Methods: In this study, Sexual satisfaction after hysterectomy was evaluated in 100 females, of 40- 50 years old (50 women before and after hysterectomy and 50 women without hysterectomy). Sample was chosen random from the women who had no interfering factors and they were asked necessary information through question sheets.Results: Sexual quality, desire and satisfaction after hysterectomy decreased. On the other hand dyspareunia decreased but dryness of vagina increased after hysterectomy. So dyspareunia doesn't contribute to sexual satisfaction decrease but vaginal dryness leads to it. After hysterectomy the sence of aging and depression increased and partner desire decreased. Thus, after Hysterectomy, there was a decrease in the sexual stimulation and vaginal dryness.Conclusions: Psychological changes and vaginal dryness (which is due to important organic changes, resulting from psychological factors) are the main causes for the reduction of sexual desire and satisfaction after hysterectomy. So women must supported against the psychological problems of hysterectomy and vaginal dryness should be treated is order to avoid the sexual problems.

Introduction & Objective: Systematic classification of huge new information in breast cancer biology and the devising of practical ways of using this information by breast surgeons.Materials & Methods: 1836 articles (from 1986 till 2008) were reviewed of which, 827 were chosen and 125 articles were mentioned.Results: Although the approach to a breast tumor still includes: clinical examination, imaging and sampling, but the attitude towards of it has been basically changed in recent decades.Conclusions: It seems that the gene mapping of such patient will rule an important play on role in the diagnosis and treatment of the breast tumor patients in the future.

Introduction & Objective: Diagnostic tests are important in treatment planning and prediction of the probability of gangrene in hand crushing injuries. This study determines and compares sensitivity, specificity, Positive Predictive Value and Negative Predictive Value of six common diagnostic tests of ischemia in prediction of probability of gangrene.Materials & Methods: The study has been performed on 144 crushed fingers that at presentation based on color, temperature and capillary refill were ischemic and vascular reconstruction was impossible. Conservative treatment including minimal debridment, fracture reduction, skin closure and immobilization in splint was done and sensitivity, specificity, Positive Predictive Value, Negative Predictive Value of diagnostic tests including: color, temperature, capillary refill, pinprick with gauge needle number 23, handheld Doppler and pulse oximetry in prediction of probability of gangrene was evaluated.Results: Color, capillary refill, Doppler and pulse oximetry have the greatest sensitivity (100%) and pinprick with needle has the least sensitivity (68.75%). In contrast, pinprick test has the greatest specificity (100%) and color and temperature have the least ones (17.8%). Pinprick test has the greatest Positive Predictive Value (100%), and, color capillary refill, pulse oximetry and Doppler have the greatest negative Predictive Value (100%). Negative Predictive Value for temperature is the least one (90%).Conclusions: Color, capillary refill, pulse oximetry and Doppler because of Negative Predictive Value equal to100% are invaluable, when they are normal. In contrast, pinprick with gauge needle number 23 because of Positive Predictive Value equal to 100% is invaluable when it is normal. Temperature, because of inconclusive Negative Predictive Value and Positive Predictive Value is not very helpful in treatment planning.

Introduction & Objective: The aim of this study is comparison of the effect of subcutaneous injection of bupivacaine 0.5% before and after appendectomy on the pain after surgery.Materials & Methods: A clinical trial randomized single-blind study was conducted on 150 male patients with preoperative tentative diagnosis of acute appendicitis. They were randomly divided into there groups. In group one (50 patients) bupivacaine of 0.5% was injected into the skin through a  subcutaneous tissue incision. In group 2 (50 patients) injection was performed postoperately. Group 3 (50 patients) received no injection. The pain score of patients was evaluated by the visual analogue scale (VAS) at 6, 12, 24 and 48h after surgery. Times to first analgesia request, total analgesic (pethidine) requirement in the first 48h after operation were recorded.Results: VAS6 score in the injected groups was lower than non-injected group (P<0.005). Post incisional VAS6 score was lower than preincisional score (P<0.041). There were no significant differences between other scores in groups. First request to analgesia was 5.7±3.9 h in group 1, 5.8±3.5 h in group 2 and 2.6±1.02 in group 3 (P<0.001). Total requirement of analgesic (pethidine) in the first 48 h was 46±23.69 in group 1.34± 23 mg in group 2 and 54 ± 22.7 mg in group 3 (P<0.001). Pain score at 6h (VAS6) in the group 2 was significantly lower than the control group (5.1±0/83 vs. 4/3 ±1/7; P<0.005).Conclusions: Subcutaneous injection of bupivacaine 0.5% (especially post operative) can be an effective method on post operative pain reduction, reduction of Pethidine consumption in the first 48 hour of operation and in increasing the time of the first analgesic requirement.

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology and pathogenesis. This disorder is characterized by intra-alveolar development and the deposition of microliths or calcispherites containing calcium phosphate. In approximately half of the reported cases a familial connection has been found. The lung tissue is hardened progressively leading to the deterioration of pulmonary hypertension and the occurrence of cor-pulmonale. Pulmonary fibrosis is also observed in association with PAM. Some authors have suggested that PAM may be a peculiar exudative response to a variety of hurts including pneumonia and rheumatic fever.We report tow cases that manifested PAM. Their pulmonary disease began after exposure to mustard gas in Iraq-Iran war.Our patients did not have any positive familial history of the disease. The diagnosis of microlithiasis was confirmed by chest X-Ray and lung biopsy. This disease does not have any definitive treatment, but lung transplantation procedure is carried out for end stage lung disease.

Introduction & Objective: Considering the unfavorable mental and physical effects of post-operative pain and the necessity of having effective drugs with least side effects, which should also be accessible and easy to use, this study was carried out to compare parenteral pethidine and sublingual buprenorphine on postoperative pain management of colorectal surgeries.Materials & Methods: Patients undergoing elective colorectal surgeries at the surgery ward of Rasool Akram hospital were assigned randomly to two groups of sublingual buprenorphine (0.4 mg tablets) and parenteral pethidine (75mg doses) receivers. The severity of patients’ pain and its changes were evaluated by Visual Analogue Scale (VAS). Also the drugs’ side effects and patients’ satisfaction were assessed.Results: The severity of pain, which had no significant difference in the two groups in recovery room, in the next measures, were always less in the group of sublingual buprenorphine receivers than in the group receiving parenteral pethidine. The Repeated Measures ANOVA test showed that the intervention group had a significant effect on patients’ pain severity (P<0.001). The amount of side effects in the two groups had not significant difference (P>0.05). Patients’ satisfaction in the sublingual buprenorphine receiving group was more than the case of parenteral pethidine receiving group (P<0.001).Conclusions: It seems that sublingual buprenorphine is an effective and less harmful drug in managing patients’ post-operative pain and its effectiveness is more than parenteral pethidine. Thus, considering the easier method of its application, it is recommended to use sublingual buprenorphine for the post-operative pain management of colorectal surgeries.

Introduction & Objective: Actinidia deliciosa (kiwi fruit) is used as a meat tenderizer. It acts rapidly and efficiently to soften meat and even to crush it, if it is allowed to work for more than a few hours. Observing this effect and considering the lack of studies addressing this subject in the literature, the authors decided to investigate the use of this natural remedy in an animal model.Materials & Methods: Thirty-five male rats were divided randomly into three groups. Under general anesthesia, a limited standard 3rd degree burn was produced on the back of each rat. For the intervention group (G1, 15 rats), the wounds were covered with fresh kiwi fruit; for control groups 2 and 3 (G2, 15 rats; G3, 5 rats), the dressing was a neutral ointment (Emulsifier the 1220). Weekly wound observations were documented for all groups. Groups 1 and 2 were sacrificed on the day 20th, and the group 3 was kept alive until complete eschar separation. The wounds of groups 1 and 2 were excised in full thickness and underwent to microscopic evaluation.Results: On the day 20th, all eschars had become detached and fallen off in the intervention group (G1), whereas in groups G2 and G3 the eschars were still firmly attached to the base of the wounds (except in two rats of group G2). This finding was statistically significant (P<0.001). The average wound surface area in group G1 was 212.3869±88.80938 mm2, whereas in the group G2 it was 388.4749±140.6967 mm2, Thus, the wound surface area was significantly (P<0.001) smaller in the intervention group. The eschars in the group G3 were separated spontaneously between days 30th and 42nd, while in all the rats of the kiwi-treated group, this phenomenon occurred before the day 20th. The pathologic study revealed no considerable differences between groups G1 and G2 (P<0.05).Conclusions: Debridement, neo-epithelialization and scar contraction were faster in the kiwi-treated group than in the untreated group. Following rapid enzymatic debridement, healing appeared to progress normally, with no evidence of damage to the adjacent healthy tissue.

Morgagni hernia, which is due to a defect in costoesternal triangle, has a very low incidence rate. Only 2 percent of morgagni hernia occurs in the left side. More than 30 percent of patients are asymptomatic and others have nonspecific symptoms. In this case report we present the case of a person with triosomy and chronic constipation that incidentally found to have morgagni hernia.

Introduction & Objective: Considering the increasing rate of varicocele disease, the choice of anesthesia for suitable surgical condition and rapid recovery and minimal side effects is very important. This study was conducted to evaluate of patient’s condition after varicocelectomy with general anesthesia Vs spinal anesthesia.Materials & Methods: In a Quasi-experimental study, 78 patients who were candidated for varicocele surgery at Emam Reza Hospital were selected sequentially. The study population was divided into two equal general and spinal anesthesia groups. All relevant data, such as demographics and clinical parameters, were registrated.Results: In this study, duration of operation, time in the operating room, first walking and feeding after operation, duration of free-pain period, pain of surgical site at 6, 12 and 24 hours after the operation, nausea and vomiting, did not show any significant difference between the two groups. In spinal anesthesia group the occurrence of headache was significantly more than general anesthesia group (P<0.03). Intraoperative erection was lower in spinal anesthesia than in the general anesthesia group (P<0.04).Conclusions: In this study, it seems that general anesthesia is useful for the decrease of postoperative complications such as headache and spinal anesthesia is useful for the decrease of intraoperative complications such as erection.