Iranian Journal of Surgery
Year:2021 | Volume:28 | Issue:4|Papers Count:9

Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and post injury induced coagulopathy, the indications for DCS have extended to the management of extra abdominal trauma and non traumatic acute abdominal emergencies. Significant progress in trauma based resuscitation techniques had le to improved outcomes and a reduction in the DCS requirement.

Introduction & Objective: Reducing mortality and disability are the main objectives of cranial decompression in patients with malignant intracranial hypertension. Hinge craniotomy (HC) is an alternative technique to decompressive craniectomy (DC), this study is designed to compare efficacy of these 2 procedures in the management of patients with malignant intracranial hypertension. Materials & Methods: Prospective, randomized, controlled trial including 38 adult patients undergoing cranial decompression who were randomly assigned to a decompressive craniectomy (n=19) or hinge craniotomy group (n=19). Postoperative variables such as ‘ Intracranial pressure (ICP) therapeutic index’ , duration of mechanical ventilation, duration of the admission in Intensive Care Unit (ICU), length of hospital stay were assessed. Radiographic outcomes were assessed by comparing preoperative and postoperative Computed Tomography (CT) scans. Postoperative complications such as infection, need for reoperation due to the lack of ICP control, wound healing problems, bone infection, etc. were recorded. Functional neurologic outcome was monitored by using the Modified Rankin Scale and Glasgow Outcome Scale in 3, 6, and 12 months after operation. Results: There was no significant difference in preoperative demographic variables between the two groups. The mean duration of mechanical ventilation, ICU admission, and hospital stay was 29± 26. 27, 32. 79± 26. 30, and 47. 16± 27. 28 days in the DC group and 24. 21± 30. 21, 27. 84± 30, and 38. 53± 35. 41 days in the HC group which showed no significant difference. There was no significant difference in the preoperative brain CT analysis between two groups. The mean Rotterdam score was 4. 53± 0. 84 and 4. 58± 0. 6 in the DC and HC group respectively, indicating no significant difference. The ratio of the largest craniotomy diameter to the largest anterior-posterior diameter of the skull was 0. 76± 0. 05 in the DC and 0. 76± 0. 04 in the HC group. The brain expansion percentage was 10. 22% in DC and 8. 69% in HC patients without a significant difference. Conclusions: It seems that HC can be a suitable alternative to the DC because of less complications rate and similar short-term and long-term outcome. By performing HC, a major surgery (cranioplasty) is reduced and the financial burden is removed from the patient and the health system.

Introduction & Objective: Hyperglycemia, which occurs during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of hyperglycemia during coronary artery bypass graft surgery has been the focus of investigation in recent years. The aim of this study was to evaluate the rate of changes in blood sugar in patients undergoing coronary artery bypass graft surgery and related factors in Dr. Heshmat Hospital affiliated to Guilan University of Medical Sciences as a referral, educational, treatment center and the only subspecialty heart center in Guilan province. Materials & Methods: This descriptive-cross sectional study was done during 2019-2020. Eligible patients’ candidate for elective CABG surgery enrolled the survey. A questionnaire was filled out containing demographic data and blood sugar at 5 measurement point times. Finally, the collected data were entered into SPSS version 21 and after examining the normality of the data, independent t test was used to compare and determine the factors associated with changes in blood sugar in patients undergoing coronary artery bypass grafting from correlation and Chi square tests. Also, to compare the mean changes in blood sugar in patients undergoing coronary artery bypass graft surgery at the times before induction of anesthesia, before the start of the pump, in the middle of the pump, after the pump and at the end of the operation, repeated measure test was used. Results: The data from 55 CABG cases were analyzed. Trend of changes was increasing and significant from baseline to the end of surgery (P ˂ 0. 0001). ASA class III, BMI > 30, age above 60, the history of DM more than 10 years and insulin administration during surgery were significantly associated with higher levels of blood sugar in 5 measurements point times (P ˂ 0. 05). Conclusions: We found that blood sugar is well controlled in CABG surgery in Heshmat hospital. But special attention should be paid to ASA class III, BMI > 30, Age above 60, insulin administration during surgery, surgery duration more than 180 minutes and the history of DM more than 10 years.

Introduction & Objective: The prevalence of Covid-19 virus is referred to as one of the most important issues in the world. Providing an effective solution to control or treat these patients type can be of great help to human society. The purpose of this paper is to provide a method for monitoring effectively the condition of patients with Covid-19 virus approaching a functional relationship called profile. Materials & Methods: In this paper, for controlling and monitoring the condition of patients with Covid-19 a solution is proposed. The existence of relationship between CD4 T cells and lymphocyte count provided the opportunity of designing a profile to monitor the condition of the patient. The information of the patients published in scientific sources is used to analyze the validation of the proposed model. Results: Although in the process of treatment of patients with Covid-19, the number of CD4 T cells and the number of lymphocytes are considered separately, this paper proposes that these two parameters should be considered in a functional relationship at the same time. The findings of this paper show that considering the proposed functional relationship provides a more effectiveness condition for a physician’ s judgment. Conclusions: The results of this research show that the profile approach provides an effective condition to analyze the status of a patient with Covid-19 considering a functional relationship between CD4 T and lymphocyte count. In addition, the results of this research are capable of leading one to use the proposed approach for evaluating vaccines and drugs prepared for this disease type.

Introduction & Objective: Recovery is one of the most important wards which require special attention. Patients in this ward could be affected by complications such as pain, shivering, nausea and vomiting and unstable hemodynamic status, which without early therapeutic intervention, poor outcomes may occur. This study was planned aiming to investigate the status of recovery ward of Alzahra hospital. Materials & Methods: In this cross sectional descriptive study, elective surgeries under general anesthesia were evaluated and according to check list vital signs, post-operative nausea vomiting, pain and shivering were documented. Results: A total of 174 cases enrolled the survey. The mean age of our patients was 40. 35 year, BMI 29. 01 kg/m2, and anesthesia duration 100. 74 minutes. 73% were in ASA class I. regarding hemodynamic status, two patients were affected by more than 20% drop in BP from baseline, and two had Sao2 less than 94%. 3. 4% complained from PONV, and 107% reported shivering. 81. 6% had no pain. Conclusions: The patients had proper conditions in recovery ward, but patient’ s age and their healthy status should be considered as well.

Introduction & Objective: Existing dressings do not have the ability to protect against damage and contamination by microorganisms ideally. The aim of this study is to obtain a scaffold of polyurethane – starch, royal jelly and hyaluronic acid by electrospinning method and a scaffold with suitable biological properties for wound healing is made. Materials & Methods: To make a nanofiber scaffold, first 10% by weight / weight of polyurethane is dissolved at room temperature for 2 hours. Royal jelly was added to the polyurethane solution in 3, 6 and 8% ratios, starch and hyaluronic acid (1% by weight / weight) and electrospinning was performed. The scaffold prepared were characterized SEM, MTT, cell culture and in-vivo of the scaffolds. Results: With the addition of royal jelly, the viscosity of the solution is increased and the diameter of the electrospun fibers is increased. In the MTT test, L929 fibroblast cells showed much better proliferation on polyurethane – starch-hyaluronic acid-royal jelly than other scaffold. Animal studies show that the percentage of recovery in the group treated with polyurethane-starch, containing hyaluronic acid and royal jelly scaffold from the seventh to the fourteenth day after the injury is higher than the percentage of wound healing in other groups and significant control group. Conclusions: Polyurethane-Starch electrospun scaffold with a content of hyaluronic acid (1% w/w) and Royal Jelly (6%) is prepared which is biologically suitable for use in skin tissue to heal wounds. Royal Jelly improves cell proliferation and adding it to scaffold also increases cellular adhesion to scaffolding. The findings of this study suggest that the use of this electrified scaffold can be effective in wound healing.

Introduction & Objective: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two distinct types of thyroid carcinoma that have different origins. An association between medullary and papillary thyroid cancer is rare and occurs as either discrete lesions or as a mixed lesion. We present the case of a patient diagnosed with synchronous medullary and PTC with bilateral lymph node metastasis. Materials & Methods: A 36-year-old man had a follow-up checkup because over the last year his serum carcinoembryonic antigen (CEA) levels had been elevated. During a thyroid examination, nodules were palpable on both sides of his thyroid gland. Ultrasound-guided fine needle aspiration showed PTC of the right lobe of the thyroid but a diagnosis could not be made for the sample from the left lobe. Total thyroidectomy was performed and after surgery, the synchronous MTC and PTC diagnosis was confirmed using the pathologic findings. Conclusions: From the pathology findings after surgery, the patient was diagnosed with synchronous MTC and PTC with bilateral lymph node metastasis. We recommend paying more attention to the synchronous emergence of these thyroid tumors in men in order to avoid misdiagnoses.