Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Misnomers in Hand Surgery
Get PDFHand surgery literature is full of disease names and terms. Some of them are misnomers, which are misleading to physicians outside the specialty. Therefore, we decided to collect all misnomers and provide them via this paper. Considering development of sciences in future, perhaps avoidance from new misnomers is impossible, but awareness of this fact, lead us to be more ingenious in interpretation. On the other hand, we believe his collection would be interesting for most specialists in hand surgery and as well informative for others
The Accuracy of Magnetic Resonance Imaging in the Diagnosis of Meniscal and Cruciate Ligament Tears of the Knee
Get PDFBackground: During the past decade, magnetic resonance imaging (MRI) has been accepted as the ideal approach for primary diagnosis of traumatic knee intra-articular lesion. Despite this, the overall diagnostic accuracy of MRI has been carefully scrutinized in Iran. The purpose of this investigation was to scrutinize the diagnostic accuracy of MRI of the knee in identifying traumatic intra-articular knee lesions.Methods: We compared MRI findings with subsequent arthroscopic findings (as the gold standard) in 107 patients (107 knees) with a clinical diagnosis of traumatic intra-articular knee lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of MRI were calculated based on arthroscopic findings for menisci and cruciate ligaments.Results: MRI showed the following results for medial meniscus: sensitivity 83%; specificity 37%; positive predictive value 46%; negative predictive value 77%; and accuracy 55%. For lateral meniscus it showed the following results: sensitivity 43%; specificity 86%; positive predictive value 40%; negative predictive value 87%; and accuracy 79%. MRI showed the following results for anterior cruciate ligament (ACL): sensitivity 62%; specificity 90%; positive predictive value 71%; negative predictive value 66%; and accuracy 75%. In addition, it showed the following results for posterior cruciate ligament (PCL): sensitivity 60%; specificity 94%; positive predictive value 42%; negative predictive value 98%; and accuracy 94%. The overall accuracy of MRI was 62.5%. We compared MRI accuracy in two time periods to investigate if there was any improvement over time. Our data showed a significant increase in the accuracy of detection of ACL injuries by MRI in more recent patients; however, there was no improvement in the diagnosis of other internal knee derangements. In addition, overall MRI accuracy was the same in patients from different age groups.Conclusions: We concluded that the overall accuracy of MRI in diagnosing intra-articular lesions of the knee in Iran is comparable with other published studies in the literature. However, it could be improved; if radiologists and orthopedists work together to find possible flaws, their cooperation would result in optimal use of this diagnostic modality
Perspectives of Iranian Medical Nurses about Do-Not-Resuscitate (DNR) Orders
Get PDFObjective: To study the attitudes of Iranian medical nurses towards the do-not-resuscitate (DNR) decision.Methods: In this cross-sectional study, 200 nurses working in Imam Khomeini Hospital, (affiliated to Tehran University of Medical Sciences, Tehran, Iran) were enrolled. They answered to a questionnaire with two sections: the first one consisted of demographic questions (age, sex, and level of education), and the second included questions about DNR orders derived from a previously conducted study by Hosaka et al.Results: A total of 168 questionnaires returned (response rate (RR=85%)). About 61% felt that DNR order is sporadically necessary. Near 66% had participated in DNRs in their practice and the most case was the patient with terminal cancer. The most common person who decided DNR orders were physicians. Sixty seven percent believed that DNR cards are useful for establishing in clinical settings.Conclusion: As DNR is not routine in Iran, enrollment of nurses in this decision should be clearly defined
Comparison of Remifentanil and Alfentanil Bolus Dose on Extubation Emergence Hemodynamic Profiles, a Randomized Double-blinded Placebo-Controlled Trial
Get PDFBackground: Hemodynamic instability is common during emergence from anesthesia which predisposes patients to development of different side effects. The primary purpose of the present study is to evaluate the effect of Remifentanil and Alfentanil on the hemodynamic profiles during and after extubation.Methods: Ninety-nine patients aged 20-50 years undergoing minor orthopedic surgery under general anesthesia were randomly allocated into control, Remifentanil and Alfentanil groups. Before extubation patients received Remifentanil (1 μg/kg), or Alfentanil (10 μg/kg) or 5 mL of Saline as a placebo based on their group. Baseline heart rate (HR), mean arterial pressure (MAP) plus systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded and documented again on extubation, and 1, 3 and 5 minutes after extubation. Cough status before and after extubation was recorded.Results: The basic characteristics of participants in all the three groups were similar. The rise in SBP on extubation in the placebo group was statistically significant compared to the Alfentanil (p=0.01) and the Remifentanil (p<0.001) groups. Mean arterial pressure decreased during the extubation in group R (97.0±13 mmHg) in contrast to other two groups (A=101.9±13 mmHg, P=101.4±13 mmHg). Heart rate increased in group A and P contrary to group R on extubation.Conclusion: Remifentanil (1μg/kg) and Alfentanil (10μg/kg) attenuate the rise in SBP on extubation but no significant changes were seen between these two drugs
Effect of Ephedrine on Pain and Hemodynamic Status on Injection of Propofol
Get PDFBackground: Propofol is one of the drugs most commonly used during induction of anesthesia. The induction dose of propofol can lead to hemodynamic changes such as hypotension and bradycardia. Pain on injection is another side effect of propofol. The purpose of this study was to evaluate the effect of two different doses of ephedrine on hemodynamic status and pain on injection of propofol compared to lidocaine and placebo.Methods: In the present study, 100 patients were enrolled. A 22 gauge cannula was inserted into the veins on the non-dominant hand of all patients. The patients were randomly allocated to 4 groups and 10 ml/kg of saline was administered over 10 minutes from each of the cannulas. Then, patients received either of these pretreatments: 2 ml of Saline (group S); 2 ml lidocaine 2% (40 mg) (group L); Ephedrine (30 ug/kg) (group E1); or Ephedrine (70 ug/kg) (group E2). After 30 seconds all patients were administered 2.5 mg/kg of propofol with a rate of 1 ml per second. The patients were asked to give a score from 0 to 10 (0 = no pain and 10 = most severe pain) every 5 seconds until loss of consciousness. Systolic and diastolic pressures and heart rate were recorded before induction of anesthesia, before intubation, and 1, 3, and 5 minutes after intubation.Results: Systolic, diastolic, and mean arterial pressure and heart rate following induction in E1 and E2 groups were higher than S and L groups (P < 0.001). There were no differences in systolic, diastolic, and mean arterial pressure and heart rate 1, 3, and 5 minutes after intubation between groups. Lidocaine and both doses of ephedrine reduced pain on injection of propofol similarly.Conclusions: Lidocaine and high and low doses of ephedrine reduce the intensity of pain on injection of propofol. Small doses of ephedrine attenuate blood pressure and heart rate reduction after induction of anesthesia with propofol
Comparison of the Rate of Thyroid Malignancies in Patient with Single Thyroid Nodules and Multi-Nodular Goiter
Get PDFBackground: Thyroid nodules are a common clinical finding and differentiating benign ones from malignant ones is a clinical challenge. The aim of this study was to compare the rate of thyroid malignancies in patients with single thyroid nodules (STN) and multi-nodular goiter (MNG).Methods: This retrospective study was conducted on 200 patients who underwent surgical thyroidectomy, between 2008 and 2010, in Shariati hospital, affiliated with Tehran University of Medical Sciences. Data analysis performed using SPSS (version 13).Results: Of these, 63 patients (12 male and 51 female) had STN and 137 subjects (28 male and 109 female) were MNG. The mean ± standard deviation of age in patients with STN and MNG were 39.1 ± 7.1 and 42.7 ± 6.2, respectively. The two groups had no significant difference in age or sex. The rate of thyroid malignancies in patients with MNG and STN were 34.4% and 36.5% respectively, showing no significance difference.Conclusions: The study did not show any statistically significant difference between the frequency of malignant and benign nodules in single and multiple thyroid. Therefore, performing accurate pathologic assessment is recommended for all cases of thyroid nodules (MNG or STN)
The Effects of Sex Hormones on Liver Regeneration after Liver Trauma in Animal Model
Get PDFBackground: The surgical management of liver injuries remains a great challenge for the traumatologists and general surgeons. We hypothesized that administration of 17 â-estradiol, a female sex hormone, improves hepatocellular healing after liver trauma.Methods: In an experimental model, 60 rats were divided into six subgroups: A (male control), B (male and estradiol), C (castrated male and estradiol), D (female control), F (female and estradiol), and G (oopherectomized female). After inducing liver trauma, estradiol subgroups received 3 doses of intravenous 17 â-estradiol (1 mg/kg) every 8 hours. 2 weeks post trauma, animals were sacrificed and hepatocellular regeneration was measured with the help of stereologic parameters of regeneration. Hepatocellular healing was compared between previous left lobe samples and the new post-traumatic right lobe samples.Results: Stereological parameters of rats receiving 17 b-estradiol after trauma was much better regarding mean angiogenesis point counting and volume density, compared with non-receiver groups after 2 weeks of trauma (P < 0.005). There was no significant difference for hepatocyte nucleus, hepatocyte point counting and volume density between estradiol receiver and non-receiver groups. In a comparison between subgroups, female sex had the same effect as giving estradiol. Oopherectomized female rats had more fibrogenesis but less angiogenesis (P < 0.005). Fibrogenesis was more in groups that were estradiol non-receiver (P < 0.005). In an explicit comparison of control females and males, estradiol infused males and females, and castrated male or oopherectomized female groups showed that stereological parameters of hepatocyte and hepatocyte nucleus were lower in female subgroups, but angiogenesis was better for female groups except for oopherectomized females.Conclusions: This study did support the administration of exogenic female hormone as an approach to augment the angiogenesis as a good index of regeneration for traumatic liver in rats
Iatrogenic Innominate Vein Injury during Percutaneous Perm-Catheter Placement
Get PDFLarge vessels injury is a rare but serious complication of percutaneous central venous catheter placement, which can be fatal. Herein a case of right innominate vein perforation during right internal jugular permcatheter placement - resulted in thoracotomy because of patient’s hemodynamic instability - is reported
Comparison of Methoxyisobutylisonitrile Scintigraphy and Ultrasonography in Preoperative Localization of Secondary Hyperparathyroidism
Get PDFBackground: In patients with secondary hyperparathyroidism, the four glands are not uniformly enlarged; therefore, preoperative localization is difficult in comparison with primary hyperparathyroidism. The aim of this study was to compare the usefulness of 99mTc-sestamibi scintigraphy versus ultrasonography in the preoperative assessment of patients with secondary hyperparathyroidism.Methods: Between October 2008 and March 2012, 25 uremic patients with secondary hyperparathyroidism underwent 99mTc-sestamibi scintigraphy and high resolution ultrasonography before total or subtotal parathyroidectomy. We measured plasma concentration of intact parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) before parathyroidectomy.Results: Sensitivity and positive predictive value (PPV), respectively, were 47.3% and 97.8% for MIBI scintigraphy, and 69.5% and 96.9% for ultrasonography. The sensitivity of combined techniques was 84.2%. There was a positive correlation between the parathyroid glands’ weight and serum calcium level, and positive MIBI scintigraphy and ultrasonography results. However, there was no correlation between the preoperative serum PTH, phosphorus, alkaline phosphatase (ALP), dialysis duration, and parathyroid glands’ weight.Conclusions: Ultrasonography is a reliable non-invasive localization tool. It has greater sensitivity in localizing parathyroid glands in secondary hyperparathyroidism than scintigraphy