Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Hypertension after Bilateral Nephron Sparing Surgery for Bilateral Wilms
Get PDFBackground: Nephron sparing surgery (NSS) for unilateral Wilms tumor (WT) has been debated recently and is being used to preserve kidney tissue and function. However, NSS is feasible only for selected cases with higher local relapse rates. There is a significant reduction of nephrons with the development of renal hypertension and progressive renal failure. In this paper, we have analyzed outcomes after bilateral partial nephrectomy (PN) and unilateral partial plus contralateral total nephrectomy in our patients with bilateral WT.Methods: We have analyzed our four patients (8 kidneys) with bilateral WT and 8 unilateral complete resection. Kidney size was measured using volumetric analysis computed tomography scan imaging. The patients were matched with children who had undergone imaging of the abdomen for other malignancies.Results: Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (60.9 cm3) were significantly greater than the reference kidneys. Total kidney volume was significantly larger after bilateral PN (98.1 cm3) versus unilateral partial plus total contralateral nephrectomy (60.9 cm3).Conclusions: Our findings suggest that patients with bilateral WT benefit from bilateral NSS. Hypertension is less common after bilateral PN. However, rates of local relapse or disease associated death are separately between the groups
Evaluation of the Effect of Intravenous Ondansetron versus Placebo before Anesthesia on Vomiting after Endoscopy and Colonoscopy Procedures
Get PDFBackground: Vomiting is a common complication after endoscopic procedures in children. Different medications could be administered to control vomiting after endoscopy. The goal of this study is to evaluate anti-emetic effects of ondansetron in children who undergo endoscopic procedures.Methods: In this clinical randomized trial, 198 children (103 female/95 male) were randomly assigned into one of the following two studied groups. Case group (G1): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + ondansetron 0.15 mg/kg and control group (G2): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + 2 cc normal saline.Results: The mean age was 6.3 ± 3.5 years (6.2 ± 3.6 years in G1 vs. 6.4 ± 3.5 years in G2). The most common cause of endoscopy procedure in both groups was hematochezia. Vomiting, recovery time, Paediatric Anesthesia Emergence Delirium (PAED), and Aldrete scores were compared. Rate of vomiting after recovery and Aldrete score were significantly different between the two groups.Conclusions:Ondansetron is effective in controlling vomiting after colonoscopy and upper gastrointestinal endoscopic procedures. Also, patients in intervention group experienced better recovery time
Pancreas Transplantation: A Review of Literature
Get PDFPancreas transplantation has emerged as an effective treatment for patients with diabetes mellitus, especially those with established end-stage renal disease. Surgical and immunosuppressive advances have significantly improved allograft survival. The procedure reduces mortality compared with diabetic kidney transplant recipients and waitlisted patients. Improvements in diabetic nephropathy and retinopathy have also been demonstrated. Pancreas transplantation can improve cardiovascular risk profiles, improve cardiac function, and decrease cardiovascular events. Finally, improvements in diabetic neuropathy and quality of life can result from pancreas transplantation. Pancreas transplantation remains the most effective method to establish durable euglycemia for patients with diabetes mellitus
Readmission Risk Factors in Patients of General Surgery Wards in Shiraz Hospitals: Applying LACE Index as a Predictive Indicator
Get PDFBackground: Today, the effective use of limited health care resources is increasingly regarded. Reduction of the readmission is one of the key tools can improve health outcomes and considered as one of the control levers that reduces health costs. Identifying the causes of readmission to the hospital helps to utilize hospital beds and facilities a more efficiently.Methods: This case-control study had been conducted in general surgery (GS) wards in 2011-2012. Using chisquare test, t-test, and multiple regressions, we studied risk factors associated with readmission in both groups of case and control. Finally, the predictive power of the Length of stay, Acuity of illness, Co morbidity of the patient, Emergency (LACE) index was evaluated using receiver operating characteristic (ROC) curve.Results: About 20% of patients in GS wards were admitted within 30 days. There is a significant difference between the two groups in the following variables: age, sex, length of hospital stay, marital status, discharge season, congestive heart failure, diabetes and renal failure. The rate of readmission with LACE index which is compared with the ROC curve shows that it is significant (P < 0.001 and Kappa = 0.22).Conclusions: Awareness of the prevalence and risk factors of readmission is effective in planning and decision making for using hospital facilities efficiently. Identifying patients at risk of readmission and erforming training plan, ischarging and following up medical programs can reduce the rate of readmission and costs of hospital. Predicting readmission can be very effective but identifying an effective index is very difficult
Effect of Magnesium Sulfate on Hemodynamic Changes During Sternotomy and Laryngoscopy in Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial
No full textBackground: This study was designed to evaluate the effectiveness of low and high dose magnesium sulfate in reducing pressure responses to laryngoscopy and sternotomy.Methods: A total of 90 patients were assigned into three groups. The patients in Group L received a 20 mg/kg bolus dose of magnesium sulfate 3 minutes before intubation followed by an infusion of magnesium sulfate (10 mg/kg/h) in contrast to 40 mg/kg of magnesium sulfate followed by an infusion of 20 mg/kg/h magnesium sulfate administered to Group H. Patients in Group P received saline as placebo. Heart rate and mean arterial pressure (MAP) recorded at the baseline were noted down again before intubation and 30 seconds, 2 and 4 minutes after intubation and 1 minute before, and 30 seconds, 2 and 4 minutes after sternotomy.Results: MAP in Groups L and H compared to Group P was significantly lower, after intubation (P = 0.0040). The difference between MAP in Groups L and H was only statistically significant 30 seconds after intubation. MAP 30 seconds and 2 minutes after sternotomy was statistically different between Groups L and H compared to Group P. The difference between Groups H and P was only statistically significant before sternotomy and 4 minutes after sternotomy (P = 0.0001).Conclusions: A low dose magnesium sulfate attenuates the hemodynamic response to laryngoscopy and sternotomy in coronary artery bypass graft surgery
Simultaneous Helicobacter Pylori Infection in Gastric Mucosa and Gallbladder Mucosa in Patients with Cholecystitis; Is There Any Relationship?
Get PDFBackground: This study aimed to assess the prevalence of Helicobacter pylori infection in gastric and gallbladder in patients with acute cholecystitis or symptomatic cholelitiasis undergoing cholecystectomy.Methods: 43 patients with biliary disease (cholecystitis or cholelitiasis) with inclusion criteria were selected in Shahid Modarres Hospital, Tehran, Iran. The data including age, sex, and the presence of Helicobacter pylori in biopsy samples of gallbladder and gastric mucosa for each patient were recorded and analyzed using SPSS software.Results: The biopsy specimens of gastric and gallbladder mucosa of 43 patients with the mean age of 54.8 ± 9.9 years were studied. 22 (51.2%) patients had acute cholecystitis and 21 (48.8%) had cholelithiasis. Among the gastric samples, 14 patients (32.6%) (9 men and 5 women) and in the gallbladder samples, 19 patients (44.2%) (8 women and 11 men) were positive for Helicobacter pylori. The simultaneous presence of Helicobacter pylori in the gastric and gallbladder mucosa was seen in 6 patients (13.9%). 10 patients (23.2%) were smokers, and 33 (76.7%) were non-smokers.Conclusions: It can be said that the presence of Helicobacter pylori in gallbladder can play an important role in the creation and spread of the infection. But the simultaneous presence of Helicobacter pylori infection in gastric and gallbladder cannot be a good standard to evaluate the diseases of the bile ducts
Alveolar Soft-part Sarcoma of the Retro Peritoneum: A Case Report and Review of the Literature
Get PDFBackground: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm originating from soft tissue. It was initially described as a distinctive clinical entity by Christopherson et al. in 1952. The peak age of incidence is between 15 and 35 years with slight sex predominance among women. The most common sites involved include extremities and trunk and in young adults and head and neck in children. ASPS is a slow-growing tumor with unusual patterns of metastasis which runs a poor prognosis. The aim of this article was to present a case of ASPS of retroperitoneal origin along with its diagnostic and therapeutic workups. Case Report: A 31-year-old patients with a chief complain of an abdominal mass in right lower quadrant, underwent surgical resection as a neuroendocrine tumor according to pre-operative imaging studies. Pathology reported the lesion as ASPS. The patient refused adjuvant chemotherapy and unfortunately he did not show up to continue his treatment and further follow-ups. A careful investigation would be required including clinical findings, clinicopathological correlation, with appropriate radiological studies, before definitive treatment of ASPS.Conclusions: The main problem to gain an extended insight into clinical features and optimal treatment is the rarity of the disease. Given the ineffectiveness of current treatments in advanced ASPS, further future investigation to find new therapeutic options would be required
Evaluation of a Sentinel Lymph Node Biopsy with Patent Blue in Locally Advanced Gastric Cancer
Get PDFBackground: A sentinel lymph node (SLN) biopsy is an interesting issue in the field of surgical oncology and has recently been introduced to the treatment of gastric cancer. The purpose of this study is to assess accuracy, sensitivity, specificity, and false negative rates (FNRs) of SLN biopsies, and to ascertain whether or not this procedure is useful for locally advanced gastric cancer.Methods: From December 2013 to March 2014, 22 patients with gastric cancer were enrolled in this study. After laparotomy, patent blue was injected around the tumor subserosaly, resection was then done, and SLNs were detected on a back table. Afterward, D2 dissection was carried out. Finally, SLNs and other specimens were submitted for permanent pathology.Results: SLNs were detected in 20 of 22 patients. The total number of SLNs was 87. SLNs were positive in 7 patients, and the total number of positive SLNs was 17. In three patients, the SLNs were negative, whereas other LNs were positive, with an FNR of 15%. 18 patients received neoadjuvant. Complete pathologic responses with negative LNs were seen in 3 patients. Accuracy, sensitivity, specificity, and negative predictive values were 80%, 66%, 90%, and 76%, respectively.Conclusions: This research demonstrated that SLN mapping in advanced gastric cancer is an appropriate method with acceptable levels of accuracy, sensitivity, and negative predictive values, even in those patients who received neoadjuvant treatment
The Effect of Intravenous Infusion of Magnesium Sulfate During Bimaxillary Orthognathic Surgery on Post-operative Pain: A Clinical Trial
Get PDFBackground: This prospective randomized controlled clinical study aimed to investigate the effect of magnesium sulfate (MgSO4) on pain management post orthognathic surgery. Methods: In this study, 52 patients undergoing orthognatic surgery were randomly allocated to receive MgSO4 or saline intravenously. The intervention group (n = 26) received intravenous MgSO4 (30 mg/kg bolus for 15 minutes immediately before anesthesia induction followed by 10 mg/kg/h dissolved in saline via pump infusion) and the second group (n = 26) received the placebo in the same bolus volume as a normal saline in a 15 minute intravenous infusion which was continued until the end of the operation. A visual analog scale (VAS) was used to determine the intensity of pain. Invasive arterial blood pressure and valid and invalid analgesic demand were also recorded. Side effects were recorded, as well. Results: This study was conducted on 52 patients, 26 per group. The results showed no statistically significant differences between the two groups with respect to demographics. During the post-operative period, the patients in the control group showed larger analgesic requirement 7 (26.9%) compared to those in the magnesium group 4 (15.4%) and the difference was not statistically significant (P = 0.308). The post-operative VAS scores evaluated serially from the recovery room also showed a significant difference between the intervention 3 (11.5%) and the control group 14 (53.8%) after the surgery (P = 0.001). However, no significant difference was found between the two groups regarding VAS scores in the surgical ward [7 (26.9%) vs. 8 (30.8%) P = 0.760]. Conclusions: Intra-operative administration of intravenous MgSO4 reduced opioid consumption for pain after bimaxillary orthognathic operations