Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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The Effect of Premedication by Remifentanil and Magnesium Sulfate in Hemodynamic Responses to Tracheal Intubation in Cesarean Section Delivery: 1 A Randomized Double-Blinded Controlled Study
Get PDFBackground: The preventing effects of remifentanil and magnesium sulfate on hemodynamic responses to tracheal intubation were evaluated in a double-blinded controlled trial on pregnant women undergoing cesarean section delivery.Methods: A total of 54 American Society of Anesthesiologists Class I-II women candidate for cesarean section delivery were randomly assigned to one of three groups (n = 18) to receive one of the following premedication: Intravenous (IV) remifentanil 0.75 µg/kg, IV magnesium sulfate 30 mg/kg, or IV normal saline 10 cc as placebo. All hemodynamic profiles were recorded immediately before and after intubation, and 2, 3, 5 minutes after tracheal intubation.Results: Heart rate and systolic and diastolic blood pressures were significantly lower in the remifentanil group than in other groups both before and immediately after intubation. The trend of the changes in homodynamic responses within 5 minutes following intubation in the magnesium sulfate and placebo group was similar, but this trend in the remifentanil group was significant difference. In the same time, 1st and 5th minute Apgar scores were slightly lower in the remifentanil group than others. The measured parameters of umbilical cord blood pH and PO had no significant differences between the groups.Conclusions: Remifentanil can attenuate hemodynamic response to tracheal intubation more effectively than magnesium sulfate, and thus it can be considered safe for a pregnant candidate for cesarean section
Cervical Spondylotic Myelopathy, Be Vigilant of Miscellaneous Presentations: A Case Series
Get PDFBackground: Cervical spondylotic myelopathy (CSM) is the result of prolonged compression of the central spinal canal. Clinical and radiological manifestations of CSM could be misleading and physicians need to be vigilant while evaluating patients with neurologic complaints otherwise delay in diagnosis and management would happen that could finally lead to a poor outcome. The aim of this study was to report our series of patients with CSM to reiterate that CSM could have diverse manifestations, and it can be only identified if the physicians are aware and do a thorough investigation. The progressive nature of CSM makes its early diagnosis and subsequent appropriate management vital to avoid further complications.Methods: A total of 10 patients who had diagnosed with CSM and undergone surgical treatment at our institute evaluated according to the pre-operative and post-operative Nurrick classification and also pre-operative history and physical examination findings and elecrodiagnostic examination.Conclusions: Because of progressive nature CSM and wide range of clinical manifestation, high index of suspicion, early diagnosis and early treatment prior to permanent spinal cord injury is recommended
Blood Products Use in Bimaxillary Orthognathic Surgeries: A Retrospective Study
Get PDFBackground: The purpose of this study was to determine the consumption of blood products during orthognathic surgeries by age, sex, blood group, operation time, and the amount of blood loss. Methods: This is a retrospective cohort study. Patients who underwent bimaxillary osteotomy were studied. The study focused on types and amount of blood loss, blood products used, and change in patient’s hemoglobin (Hb) and hematocrit (HCT). Patients’ demographic data, blood type, and duration of surgery were variables of the research. Results: A total of 133 patients (52 males and 81 females) with a mean age of 22.950 ± 4.241 years formed the study population. Average blood loss was 556.32 ± 245.05 ml and the average operating time was 259.96 ± 51.56 minutes. Results demonstrated that duration of the surgical and blood loss in males was higher than females. The mean of Hb and HCT levels before surgeries was 13.56 ± 1.30 and 40.47 ± 4.30, respectively, which significantly (P < 0.001) decreased to 11.969 ± 1.200 and 35.782 ± 3.800 1 day after the operations. The transfused blood products consisted of packed cells (5.4%), fresh frozen plasma (37.3%), and hydroxyethyl starch (57.3%). The percentage of patients who did not receive any transfusion was generally higher in the positive blood types than negative ones, with the highest percentage being in the AB+ group. Conclusions: A risk of using blood products particularly packed cells may increase if blood loss was above of 800 ml and surgical duration more than 300 minutes. The duration of orthognathic surgery may have a significant effect on blood loss and blood transfusions. It seems subjects with positive blood types may have a lower risk for transfusion
Long-term Results after Restoring Flexor Tendon Injury in Children Younger than Age 10 Years
Get PDFBackground: In regard to the rarity of pediatric tendon lacerations compared with the adult population, sparse knowledge exists. Published reports indicate that the incidence of “good” flexor tendon repair outcomes is low. This study aimed to determine the injury pattern and demographics of pediatric flexor tendon injuries over the past decade.Methods: A retrospective chart review of all flexor tendon injuries between 2005 and 2015 was performed. Parameters reviewed included demographics, injury mechanism, repair technique, outcomes, and complications.Results: A total of 20 patients with a median age of 4 years and 4 months experienced 45 tendon injuries. The most common cause of injury was glass (n = 10), with the most common digit injured being the index finger (n = 8). Zone II had the highest number of injuries (n = 14). The modified Kessler core and peripheral running sutures technique were used in all primary repairs (n = 18). Using author designed evaluation system, 80% of patients experienced excellent recovery. Four patients had good results. Only one patient complicated with rupture necessitating further surgery that its final evaluation was excellent.Conclusions: The outcome of restoring flexor tendon injury of children is satisfactory, and we recommend that
Comparison of Complete Sinus Excision and Reconstruction with Sinus Excision and Umbilical Preservation for Treatment of Umbilical Pilonidal Sinus
Get PDFBackground: Umbilical pilonidal sinus is a granulomatous reaction to hair shaft penetrating the epidermis of umbilicus from the external surface. In this study, the outcome of complete excision of the umbilical sinus with umbilical reconstruction and sinus excision with umbilical preservation is considered.Methods: This study was a clinical trial. In this study, 60 subjects with umbilical pilonidal sinus were enrolled into two groups (Group I, complete excision of the umbilical sinus with umbilical reconstruction, n = 30, Group II, sinus excision with umbilical preservation n = 30). Discharge, bulging, pain, bleeding, and itching of umbilicus and existence of hair were registered in the base visit and then 1 and 2 weeks, and 1, 3, and 6 monthslater. Patients with umbilical pilonidal sinus, who had not undergone any previous surgeries, were operated on using a technique that involves complete excision of the umbilical sinus followed by reconstruction of the umbilicus or sinus excision with umbilical preservation. Patients were then followed and wound complications,and recurrence were evaluated at post-operative visits (1 week, 2 weeks, 1 month, 3 months, and 6 months later). Remission and relapse of each symptom were compared. Data were analyzed by SPSS version 16.Results: A total of 60 patients underwent the operation; 55 (91.7%) were male, and 5 (8.3%) were female. The mean age in Group I, complete excision of the umbilical sinus with umbilical reconstruction was 29.9 years (18-45 years) and mean age of Group II, sinus excision with umbilical preservation was 28 years (19-42). Themean follow-up period was ٦ months. Only one patient in Group I, complete excision of the umbilical sinus with umbilical reconstruction had seroma and hyperemia of the skin after the operation, and treated conservatively at an outpatient clinic. No recurrence was observed during the follow-up period, and the most patients were satisfied with the appearance of their umbilicus. The two groups were not different by the meansof age, sex and symptoms at baseline (P > 0.050). Remission of symptoms were not significantly different inthe two groups (P > 0.050). The probability of relapse of other symptoms were not different in two groups (P > 0.050).Conclusions: Umbilical sinus excision with umbilical reconstruction is a relatively simple and effectivesurgical option for treating umbilical pilonidal disease with acceptable patient satisfaction and no serious complications. It may also be associated with a low risk of recurrence
Design and Evaluation of the “Preparation Course for New Entrant Assistants” on the Awareness and Skills of Newly Arrived Surgery Resident
Get PDFBackground: Beginning of assistance course is associated with anxiety. This due to unfamiliarity with the assistance and insufficient training, knowledge, and required skills. The aims of this study were to design, implement and evaluate the effects of a period of 1-month as “preparation course for new entrant assistants” on the awareness and skills of newly arrived residents.Methods: 12 newly arrived assistant student were divided into two equal groups. Some steps such as understanding the environment and legislation, education about an emergency, and dealing with patients and also, suturing, chest tube insertion, and cut down skills were passed by the first group before starting the assistance course. The second group was entered in the assistance course without this preparation course. For performance evaluation and comparison of these two groups, four questionnaires were created and filled consequently before the entrance, at the end of the 2nd month, based on direct observation of procedural skills (DOPS) exam, and at the end of 6th month.Results: There were no significant differences between two groups at the beginning of the study (P < 0.05). At the end of the 2nd month, the first group had better performance in understanding the environment, patient examination, diagnosis and emergency skills in comparison to the second group (P < 0.05). Based on the DOPS score, the first group had significantly better performance (P < 0.05) except in performing cut-down (P > 0.05). Also procedure, the first group was better than the second group just in the consensus of the procedure (P < 0.05). Finally, at the end of the 6th month, the difference between two groups was becoming lower, and supervisors believed that after additional 3 months, this difference would be lost.Conclusions: Conducting a 1-month period of preparation for new entrant assistants can be useful in increasing awareness, understanding the environment, performance, the knowledge of the theory and how to deal with patients as well as increase their skills in performing the expected procedures
Phantom Tumor of the Lung
Get PDFBackground: Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s) are uncommon but well-known entities.Case Report: The patient is a 60-year-old male with a history of dyspnea and surgical removal of kidney stonein 1 year ago.Results: In chest-X-ray prior to the surgery an olive-shaped homogenous density, with a size of 30 mm × 20 mm in the right lung have been detected. Computed tomography (CT) scan has been performed, and a homogenous mass with a well-delineated border in major fissure of the right lung and mediastinal lymphadenopathy had been detected. Serial CT scans revealed mass enlargement. In Ct guided, Transthoracic biopsy fluid collection along the major fissure of the right lung had been detected. Biopsy of mediastinal lymph node silicoanthracotic changes with focal hyaline fibrosis had been shown.Conclusions: The diagnosis of the phantom tumor must be considered in any patient with congestive heart failure and lung mass. In this patient, there was no history of congestive heart failure which shows that phantom tumor could happen in non-chronic heart failure patients. Although the accurate diagnosis of the phantom tumor with imaging modalities in patients without congestive heart failure is very difficult but at least this diagnosis must be considered in a patient with a lung mass in the major fissure of the lungs
Asymptomatic Giant Left Atrium: Do Atrial Size Changes After Successful Valve Replacement? 7-Years Follow-up Case Report
Get PDFBackground: Giant left atrium (GLA) associated with mitral valve surgery reported to have a mortality ranging from 8% to 32%. Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. Either we must do or not do a reduction arterioplasty at the time of the mitral valve surgery is a controversy in the literature.Case Report: The patient had mitral valve replacement with a with a 31 mm carbomedics mechanical valve prosthesis 7 years past during her last visit. No reduction arterioplasty was done with a valve operation. Her 7-years close follow-up was uneventful. In the last visit, echocardiography and spiral chest computerized tomography scanning were requested. In both of the requested images giant left trial enlargement was seen, but the patient was without symptoms regarding her giant left atrium.Conclusions: In this case report, it seems that if we want left atrial size decline, it is necessary to have reduction arterioplasty during mitral valve surgery. However, it does not mean a definite therapeutic efficacy, especially when considering future symptoms
The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department
Get PDFBackground: Pain could potentially affect all aspects of patient admission course and outcome in emergency department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually, and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments.Methods: In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in pain patterns regarding different aspects of trauma injuries in these two groups were compared.Results: The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a supplementary pharmacological intervention.Conclusions: Pharmacological management of pain in patients with trauma is shown to be significantly beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain management of patients with trauma