Iranian Journal of Surgery
Year:2013 | Volume:21 | Issue:1|Papers Count:8

Introduction & Objective: Osteotomy is the classic operation for the treatment of patients with primary degenerative osteoarthritis and for the correction of their deformity. Considering the existence of different methods for their treatment, preoperational assessment and its comparison with post operation measures has a significant role in determining the prosperity of surgery and patient's follow up. The aim of this study is to investigate the radiologic changes in these patients.Materials & Methods: In a case series study from 2004 to 2010 in Shafa Yahyaeeian hospital (a referral hospital in Tehran, Iran) patients with osteoarthritis who had signs and symptoms of medial compartment of knee and varus deformity underwent open wedge tibial osteotomy. Using anteroposterior and lateral radiography in standing position, the limbs alignment before and after the operation were investigated.Results: Totally 29 patients (36 knees) were investigated. Fourteen patients were females. All of them were younger than 50 years with mean ±SD (27.64 ±10.88). The follow up time was (4.33 ± 1.7). Tibial slope and grade DJD increased after operation. Insall-salvati and Blackburn-peel indices had no change. Two cases were not corrected completely, due to simultaneous deformity in the distal of femur. Three cases had fracture of lateral plateau due to some technical problems during operation. They had little dislocation and were treated completely in next follow up by using nonsurgical treatment.Conclusions: Open wedge osteotomy can have good results in the radiologic finding and deformity correction of patients with primary degenerative osteoarthritis.

Introduction & Objective: Following the failure of non-surgical techniques, surgical approaches have been introduced in order to help morbid obese patients to achieve their optimal weight. Laparoscopic adjustable gastric banding (LAGB) has been considered as one of the most favorable methods among both patients and surgeons. The recent article is a report of 165 patients who underwent LAGB when referred to a private medical center.Materials & Methods: This study was a cross-sectional, performed between January 2005 and February 2012 on 165 obese patients with body mass index (BMI) between 32 and 50 kg/m2, and who had undergone LAGB. The subsequent complications were recorded during the patient’s follow-up periods. Analytic analysis was performed using frequency indices and Chi square and T-tests.Results: The mean operation time from the insertion of the first port to the final suture was 20.1±2.3 minutes. The mean hospital stay was 17.8±0.8 hours and the mean time to return to work was 6.1±0.4 days. The mean weight reduction was 21.4±0.9 kg. Thirty-nine patients (23.6%) experienced complications, including 21 (12.7%) slippages, 11 (6.6%) port infections,6 (3.6%) erosions and one (0.6%)phrenic nerve irritation during the 16.9±0.9 months follow-up period.Conclusions: Using new modalities in surgical treatments can be one of the most appropriate treatments to reduce weight. Appropriate case selections and describing the complications to patients, may be helpful in reducing the side effects and obtaining more realistic findings.

Surgical correction of kyphoscoliosis may result in spinal cord injury and neurologic deficits. Multimodal intraoperative monitoring (MIOM) may allow for early detection and reversal of spinal cord and nerve roots potential injuries. In three consecutive kyphoscoliosis corrections, MIOM were performed. In all cases Somatosensory evoked potentials (SSEPs) transcranial electrical motor evoked potentials, corticospinal evoked potentials, spinal descending D motor waves, free run and/or stimulated electromyography were performed when required. None of the 3 patients had significant SSEPs changes or postoperative radiculopathies distinct from their preoperative presentations. In our cases, tceMEPs were obtained in 78.3% of the applied transcranial stimulations. Propofol or Propofol/Ketamine mixture plus narcotic is suitable to obtain stable reproducible tceMEPs. MIOM is recommended to be used in patients with scoliosis who undergo surgery for spinal deformity. Monitoring can practically reduce possibilities of neurologic deficit.

Introduction & Objective: Adhesion formation after abdominal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic abdominal pain. In this study, we evaluated the effect of normal saline on postoperative adhesion formation in a rat model.Materials & Methods: A total of 30 Wistar female rats were randomly divided in 3 groups involving Normal saline (NS) group, Control group and a group of normal animals (not include in our study). Under general anesthesia, and following a 3cm midline incision, the anterior surface of serous membrane in the rat was scraped slightly. One ml of Normal saline was administrated intraperitoneally in the NS group. The duration from opening to the beginning of the closure was 1 min. In the control group, no medication was administered, and only cecum was exposed to air for 1 min. Fourteen days after the surgery, a re-laparotomy was performed for macroscopic and pathological assessment and then all of them were destroyed. A comparison of the groups was carried out using the non-parametric Kruskal-Wallis test, followed by Mann- Whitney U statistics, to detect the statistically significant differences among the groups. Analysis was performed using SPSS 13. P-value £ 0.05 was considered significant.Results: The adhesion grade and extent of the normal saline group was lower than those of control group in macroscopic assessment (P<0.05). A comparison of the adhesion stages in pathological assessment showed a reduction in the abdominal adhesion by the usage of NS, and demonstrated a significant difference between Normal saline and control groups (P<0.05).Conclusions: Administrating normal saline has preventive effects on the postoperative abdominal adhesion.

Introduction & Objective: Many of the patients after cardiac surgery have anxiety and depression due to surgical stress and this has a negative effect on their quality of life and follow-up their treatment protocol. Thus, the aim of this study was to determine the effectiveness of massage therapy on Depression, Anxiety and stress of patients after coronary artery bypass surgery.Materials & Methods: This was a clinical trial study. In this study 72 patients (from 165 patients), who were underwent coronary artery bypass surgery were selected. This study was performed in the period of December 2010 up to May 2011 in Isfahan's Chamran hospital. Then, the patients were randomly assigned to the two case and control groups. The patients of the case group (n= 36) received Light Pressure Stroking massage for 20 minutes in 12 sessions in 4 consecutive weeks after the surgery. The patients in control group received only the routine care. The patient's depression, anxiety and stress were measured before and after the intervention with DASS 42 Questionnaire. SPSS software, version 18, and descriptive and inferential statistical methods were used for data analysis.Results: Mean (SD) scores for depression, anxiety and stress before the intervention in the case group were 21.6 (6.6), 14.4 (6.6) and 25 (6.5) and in the control group were 24.1 (6.2), 18.5 (8.4) and 27.8 (8.4) respectively; that did not show a significant difference (P > 0.05). After the intervention, scores for depression, anxiety and stress in the case group, were 12.6 (7.1), 8.2 (4.9) and 14.2 (8) and in the control group were 23.9(6.8), 17.9 (8.7) and 27.3 (8.3) respectively; that showed a significant difference (P <0.001).Conclusions: The use of massage therapy can decrease depression, anxiety and stress of patients after coronary artery bypass surgery and due to its low cost and simplicity, it can perhaps be used as a complement to drug therapy and postoperative interventions used in these patients.

Introduction & Objective: Early diagnosis of breast cancer plays a key role in decreasing t of deaths. Knowledge about the symptoms of breast cancer is a good way for its early diagnosis.Materials & Methods: This descriptive study was conducted on 400 females who attended Alzahra Hospital. A questionnaire consisting of three parts was used; 13 questions related to demographic information, 16 questions for assessing their knowledge, and 4 questions for their practice. The validity and reliability of questionnaire were confirmed. Data were analyzed with SPSS 16 and for comparison the t-test, ANOVA and Pearson correlation coefficient, were used.Results: The mean age was 48.07±6.44 and the mean score of the knowledge was 5.2 & 3.0. 57.2% of individuals had low knowledge and only 4.5 percent had high knowledge. Doing self-examination and mammography as practice, was 43.8 and 23.25 respectively. There was a direct correlation between age and knowledge score (P = 0.017). Knowledge score of women who did self breast examinations and those took mammography was significantly higher than other groups (P = 0.05). The married patients had higher knowledge score (P = 0.04). There was no relation between their level of literacy, job, financial condition, number of pregnancies, number of children, and history miscarriages or breast and ovary cancers in her or her family, with score of knowledge.Conclusions: Knowledge and practice of women about breast cancer was very low. Therefore, it is suggested to increase the knowledge of people in order to prevent late diagnosis.

Breast cancer is one of the principal causes of mortality in women of 35-65 years old. Ductal Carcinoma Insuitu is a colonal prolifration of suspicious malignant cells which accumulate in breast ducts, with no evidece of invasion to epithelial basement membarane in the neighborhood of stromal tissue.In this review study, we used clinical trials, case- control and open access studies with sufficient validity.Key words like: DCIS, HER-2 new, Tamoxifen, sentinel Lymph node biopsy, for searching in reliable sites (eg: ISI, puBMED, EMBASE) is used. The most important predicting factor for DCIS bahaviour are grade, size and tumor margin. About 50% of tumor cells Presents neuroendocrine marks like: chromogranin A, synaptophysin, CD56, somatostatin. MRI is a very helpful method for DCIS diagnosis. Breast conservative surgery followed by sonography or Mamography is a confident method for patients with DCIS without considering the histological type.