Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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The Effects of Fetal Head Circumference on The Duration of Labor and Cesarean Section in Term Pregnancy
Get PDFBackground: To investigate whether fetal head circumference (FHC), independent of estimated fetal weight(EFW), is a risk factor for prolonged second stage of labor and cesarean delivery in term pregnancy.Methods: A single-center, non-randomized cross-sectional study including 580 cases was conducted. Casesincluded singleton primigravida term pregnancies.Results: In the vaginal delivery and cesarean groups, the FHC was 35.01 ± 1.18 cm and 35.02 ± 1.32 cm,respectively (P = 0.95); biparietal diameter (BPD) was 94.99 ± 0.65 mm and 94.96 ± 0.65 mm, respectively (P =0.66); EFW was 3366.18 ± 207.04 g and 3363.03 ± 251.54 g, respectively (P = 0.34). The lengths of the first andsecond stages of labor were not associated with the type of delivery (P₁ = 0.92; P₂ = 0.79). BMI was significantlyassociated with the duration of the first stage of labor (P₁ = 0.04), but not the second stage (P₂ = 0.87). BPD wassignificantly associated with the duration of the first stage (P₁ = 0.007), but not the second stage (P₂ = 0.57). EFWwas not associated with either stage (P₁ = 0.68; P₂ = 0.73). FHC was significantly correlated with the duration ofthe second stage of labor (P < 0.01).Conclusions: Among various maternal and fetal parameters, FHC was correlated with prolonged second stageof labor without increasing the risk of cesarean delivery. The decision regarding planned cesarean should not bebased on FHC in uncomplicated pregnancies
Adjunctive Effects of Vitamin C and Thiamine on Inflammation, Oxidative Stress, and Clinical Outcomes in Sepsis
Get PDFSepsis is known as a leading cause of morbidity, mortality, and healthcare burdened all around the globe, with imited targeted therapies beyond standard supportive care. Currently, management strategies focus mostly on controlling the infection and hemodynamic stabilization but often fail to address to pathophysiological processes of inflammation, oxidative stress, and microvascular injury. Vitamin C (ascorbic acid) is a potential antioxidant and immunomodulator, and has gained attention as an adjunctive therapy due to its role in reducing oxidative damage, inflammatory responses regulation, and supporting catecholamine synthesis. In addition, the synergistic combination of vitamin C and thiamine has been proposed to enhance cellular metabolism and organ protection in patients who are critically ill. In this study, we investigated the effects of itamin C, both alone and combination with thiamine, on clinical outcomes and biochemical markers in patients with sepsis. Our findings provide new insights into the potential role of vitamin supplementation in modulating disease progression and improving prognosis, highlighting its possible integration into sepsis management strategies
Impact of Body Mass Index on Mortality and Length of Stay in Postoperative Sepsis Patients Admitted to the Shariati Hospital Intensive Care Unit 2024
Get PDFBackground: Sepsis is one of the most challenging critical conditions in patients admitted to the Intensive CareUnit (ICU), leading to increased mortality, prolonged hospital stays, and long-term complications. Body MassIndex (BMI) is a significant factor affecting the prognosis of these patients. This study aimed to investigate therelationship between BMI and mortality rate, ICU length of stay, symptoms three months post-discharge, SOFAscore, and CRP levels in patients with sepsisMethods: This cross-sectional study was conducted on 162 sepsis patients admitted to Shariati Hospital's ICU in1403. Patients were categorized into five groups based on BMI (underweight, normal weight, overweight, obese,and morbidly obese). Data on clinical outcomes, including mortality rate, ICU length of stay, SOFA score, CRPlevels, and symptoms three months post-discharge, were collected and analyzed using statistical tests such asANOVA, chi-square, and logistic regression.Results: The results showed that overweight patients had the lowest mortality rate (14.3%) and shortest ICU stay(12 days), whereas underweight (20% mortality) and morbidly obese patients (22.2% mortality) had the highestrisk. The ANOVA test indicated that BMI significantly affected ICU length of stay (p = 0.00028). Additionally,underweight and morbidly obese patients experienced the most long-term symptoms post-discharge, especiallysevere fatigue (80% and 66.7%, respectively) (p = 0.0026). The mean SOFA score was also higher in underweightand morbidly obese patients (9 and 8, respectively), indicating greater disease severity in these groups (p < 0.05).Conclusions: The findings of this study suggest that BMI can significantly impact the clinical outcomes ofpatients with sepsis. Overweight patients had better prognoses compared to other groups, while underweightand morbidly obese patients were at higher risk in terms of mortality, longer hospital stays, and post-dischargecomplications. These results could be used to optimize therapeutic and care strategies for ICU patients
Ovarian Hemorrhagic Cyst Secondary to Warfarin Overdose Following Mitral Valve Replacement: A Case Report
Get PDFWarfarin remains a cornerstone anticoagulant therapy for patients with mechanical heart valves but carries significant bleeding risks. Ovarian hemorrhagic cysts represent a rare but potentially life-threatening complication in women of reproductive age receiving anticoagulation therapy. The combination of warfarin overdose and ovarian bleeding can result in severe hemoperitoneum requiring emergency intervention. I present the case of a 48-year-old woman with a history of mitral valve replacement who was admitted to the emergency department with acute pelvic pain. The patient had been receiving warfarin therapy for mechanical valve anticoagulation and developed signs of warfarin overdose with an International Normalized Ratio of 8.9. Computed tomography revealed a large hemorrhagic ovarian cyst with associated hemoperitoneum. Conservative management was initially attempted with warfarin reversal using prothrombin complex concentrate. However, due to hemodynamic instability, the patient required emergency laparotomy. Right salpingo-oophorectomy was performed. The patient recovered fully and was discharged on postoperative day 9. Emergency physicians and surgeons should maintain high clinical suspicion for ovarian hemorrhagic complications in women of reproductive age receiving anticoagulation therapy, particularly when presenting with acute pelvic pain, oliguria, and elevated coagulation parameters. Early recognition, appropriate reversal of anticoagulation, and timely surgical intervention when indicated can prevent life-threatening complications and preserve reproductive function
Case Report of a Recurrent Sarcoma in a 57-Year-Old Female
Get PDFThis case report describes the recurrence of sarcoma in a 57-year-old female with no significant medical history.Following initial surgical excision two years prior, a large mass reappeared in the left flank and was subsequentlyremoved completely. This case highlights the challenges associated with managing recurrent sarcomas andunderscores the importance of ongoing surveillance
Video-Assisted Thoracoscopy and Open Thoracotomy for the Treatment of Stage III Empyema: A Comparative Study
Get PDFBackground: Pleural empyema can be fatal and requires surgery if untreated. Stage III empyema, markedby thickened pleura, necessitates surgical intervention. Both open thoracotomy (OT) and video-assistedthoracoscopic surgery (VATS) are viable options, but there is insufficient clinical evidence to determine whichis superior.Objective: This study evaluated the preoperative outcomes of VATS and OT in patients with stage III empyemaMethods: There were two groups of 30 patients with stage III empyema treated with OT or VATS. We measuredpatients' preoperative characteristics and analyzed them using t-tests and chi-square testsResults: No difference was seen between the mean (± SD) age of the OT (40.38 ± 19.71) and VATS group (43.56± 19.82) (p-value = 0.796). The OT group's surgery and hospital stay (2.15 ± 0.58 hours) was about 1.5 timesthe VATS procedure (1.44 ± 0.37 hours) (p-value = 0.018). Tachypnea duration (p-value = 0.174) and chest tubeduration (p-value = 0.417) were statistically similar between groups. OT patients experienced longer air leaksthan VATS patients (p-value = 0.019).Conclusions: Both procedures are effective, but VATS may be preferable due to shorter operation times, hospitalstays, and its minimally invasive nature. Further clinical trials are needed for clearer guidance
A Rare Case of Twice Perforated Appendix
Get PDFStump appendicitis is a rare complication of appendectomy. It was first described in 1945 by Rose [1]. To date,it remains both a diagnostic dilemma and a management challenge for clinicians.We present a case of a 58-year-old gentleman with a past history of appendectomy, who presented with cardinalsymptoms and signs of intestinal obstruction. Assessment with CT abdomen revealed pericecal inflammation,pneumoperitoneum, and multiple intra-abdominal collections; however, stump appendicitis was not identified.He underwent surgery, during which stump appendicitis was diagnosed intraoperatively, and a completionappendectomy was performed. We review the literature regarding the diagnostic challenges and treatmentstrategies for stump appendicitis
Intact Parathyroid Hormone (iPTH) as a Predictor of Symptomatic Hypocalcemia after Total Thyroidectomy; A Cross Sectional Study
Get PDFBackground: This study aimed to measure levels of intact parathyroid hormone (iPTH) following total orcompletion thyroidectomy, to evaluate its role in diagnosing symptomatic hypocalcemia in affected patients.Methods: This cross-sectional study was conducted on patients who underwent total or completion thyroidectomyduring 2014–2015. Serum iPTH and calcium levels were measured immediately after surgical wound closure.Hypocalcemia symptoms were assessed every 8 hours postoperatively. The relationship between serum calciumand iPTH levels was analyzed. Statistical tests included repeated measures ANOVA, t-test, Chi-square, Mann–Whitney U, and ANOVA. The optimal iPTH cut-off value was determined using receiver operating characteristic(ROC) curve analysis.Results: Of 112 surgical patients, iPTH was measured in 100 cases. Twenty patients developed symptomatichypocalcemia. There were no statistically significant differences among normocalcemic, asymptomatichypocalcemic, and symptomatic hypocalcemic groups in terms of age, preoperative calcium levels, or length ofhospitalization (P = 0.48, P = 0.46, and P = 0.6, respectively). iPTH levels differed across the groups, notablybetween asymptomatic and symptomatic hypocalcemic patients (P = 0.029). ROC analysis identified an optimaliPTH cut-off value of 18.9 pg/mL, with sensitivity and specificity of 90% and 56.52%, respectively.Conclusions: iPTH measurement immediately following thyroidectomy shows utility in predicting symptomatichypocalcemia and may play an important role in identifying patients at risk postoperatively
Dexamethasone and Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Get PDFBackground: Laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder in patients experiencing gallstones or acute cholecystitis. Pain is a common side effect of surgery. Objective: This study evaluates the effectiveness of intraperitoneal dexamethasone injection from the umbilical port site in alleviating pain after laparoscopic cholecystectomy.Methods: This research followed a triple-blind clinical trial that included 80 randomly selected patients who were hospitalized at Shahid Mohammadi Hospital in Bandar Abbas and deemed eligible for laparoscopic cholecystectomy. Patients were randomly divided into two groups, each containing 40 participants. In the test group, 8 mg of dexamethasone was injected into the intraperitoneal space through the umbilical port site during surgery, while no drug was administered in the control group. Pain scores were measured postoperatively using the VAS questionnaire at 6, 12, and 18 hours after surgery. The collected data were analyzed using SPSS version 21 statistical software, employing independent t-tests and chi-square tests. Results: The experimental group exhibited significantly lower levels of nausea, vomiting, analgesic consumption, and pain compared to the control group (p<0.000).Conclusions: Study confirmed that intraperitoneal dexamethasone infusion from the port site significantly reduced postoperative pain, nausea, vomiting, and the consumption of painkillers
The Rate of Hernia Recurrence in Surgical Patients with Mesh Repair and Non-Mesh Repair
Get PDFBackground: Hernia repair is one of the most common procedures in general surgery, which is performed byvarious methods. One of the consequences of hernia repair is the recurrence of hernia in the short or long term. In this study, the rate of hernia recurrence in surgical patients with mesh and non-mesh repair methods was investigated.Methods: This prospective cohort study was conducted on 138 patients who underwent repair surgery withmesh (28 individuals) and without mesh (110 individuals) due to hernia in Hamadan Ba’ath Hospital in 2019and 2014. The authors investigated and compared in terms of frequency of recurrence and complications. Part of the required data was obtained from the patient’s medical records and part was obtained through telephone calls. Data analysis was done with SPSS software version 26.Results: The average age of the patients was 41.2±26.25 years, 88.4% were male and 11.6% were female.The frequency of hernia recurrence was 3.6% in total, all of which were in the non-mesh repair group. Nosignificant difference was observed between hernia repair with and without mesh in terms of frequency ofrecurrence (P=0.583) and complications (P=0.964). Also, no significant relationship was observed betweenhernia recurrence with gender, age, smoking, employment status, and body mass index (P>0.05).Conclusions: Hernia repair with both methods with and without meshing have a relatively favorable short-termoutcome. Although meshing reduces hernia recurrence; However, there was no significant difference between the two methods of hernia repair with and without meshing in terms of recurrence and complications