Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Sleep Quality in Women with Endometriosis
Get PDFBackground: Endometriosis is a gynecological disorder characterized as the implantation of endometrial tissue outside the uterine cavity. Psychological symptoms such as anxiety, bipolar disorder, depressive symptom and impaired quality of life are common in these women. Sleep quality had not been considered in these women as it should be. The goal of this study was to evaluate sleep quality in women with endometriosis.Methods: In this cross-sectional study 61 married women with laparoscopically diagnosed endometriosis asked to fill valid and reliable Pittsburgh Sleep Quality Index (PSQI).Results: Mean age and mean education level were 31.4±6.7 years and 11.7±3.1 years, respectively. Dysmenorrhea followed by dyspareunia was the most common symptoms (68.8% and 40.3%). Mean PSQI score was 6.1±3.4, twenty eight (45.9%) had PSQI score equal or less than 5 and 33 (54.1%) had PSQI score more than 5 (poor sleep). Mean PSQI was significantly different between cases with and without dysmenorrhea and dyspareunia.Conclusion: Sleep quality should be considered in women with endometriosis
Comparison of Standard and Percutaneous Tracheostomy Complications in Shariati Hospital in Iran
Get PDFBackground: Tracheostomy is a procedure which aims at better managing patients’ airway. It can be done using two methods: standard and percutaneous. The percutaneous method is a favorable choice for critically illpatients because it is a less invasive procedure. This study compares the short-term complications of these two methods (during 7 days after the procedure).Methods: This study was a cross-sectional research performed on 50 ICU patients in need of tracheostomy.The patients were divided into two groups of percutaneous procedure (15 patients) and standard procedure(35 patients). The complications were registered in questionnaires and the data were analyzed using SPSS software (χ² test and t-test).Results: The two groups had no significant difference in age, sex, and vital signs. Average duration of the procedure was 24.4 minutes in the standard procedure (10-45 minutes) and 26.78 minutes (5-70 minutes) in the percutaneous procedure, and there was no significant difference between two groups (P = 0.814). Average bleeding during 7 days after the procedure was 44 cc (10-150 cc) in standard procedure and 24.7 cc (10-50 cc) in the percutaneous procedure, and the difference was significant (P = 0.012). The other variables were not significantly different in two groups.Conclusions: There was no difference in short-term complications between percutaneous and standard tracheostomy method should be selected considering other important factors
Outcome of Common Bile Duct Exploration without Intraoperative Cholangiography: a Case Series and Review of Literature
Get PDFBackground: Open or laparoscopic surgical exploration of common bile duct (CBD) is performed when endoscopic approaches fail to extract CBD stones. Intraoperative cholangiography (IOC) through T-tube is performed in order to reduce the rate of retained stones. The aim of this study was to evaluate results of CBD exploration without IOC through T-tube and reviewing existing literature.Methods: A retrospective medical chart review of 392 patients who underwent surgical CBD exploration was performed. All patients had proven CBD stones and had previously undergone failed attempts of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). T-tube insertion or biliary-enteric anastomosis was performed after open CBD exploration with regard to patient’s presentation and CBD diameter. IOC was not performed after T-tube insertion and cholangiography was postponed until 7th postoperative day. Postoperative retained stone and their management were reviewed.Results: Of 392 patients with CBD explorations, T-tube was placed in 215 (54.8%) including 66 (30.7%) emergent biliary drainage and 149 (69.3%) elective operations. A number of 177 of 392 (45.2%) patients underwent biliaryenteric anastomosis. In 6 of 215 patients (2.8%) with T-tube placement, retained CBD stones were detected by T-tube cholangiography during postoperative period. All of them were treated successfully by ERCP.Conclusions: T-tube placement without IOC is accompanied by a low rate of retained stone. Omitting IOC may decrease the operation time which is especially important in emergent cases. Retained stones following CBD exploration and T-tube placement can be treated successfully using ERCP
Delayed Haemorrhage Following Radical Gastrectomy: A Case Report
Get PDFA 53-year-old man, who underwent total gastrectomy and esophagojejunostomy due to gastric cancer, came back to the emergency ward with delayed intra-abdominal haemorrhage. The patient was suffering from a distended, painful abdomenn. The patient was hypotensive, tachycardic, and oliguric. Laboratory analysis detected severe reduced haemoglobin concentration and coagulopathy. After resuscitation and correction of coagulopathy, the patient was transferred to the operating room. At the emergency operation we found that intra-abdominal haemorrhage was from the transverse mesocolon and site of celiac lymph node dissection. Haemostasis was done by suturing, cauterization, and patches with Surgicel
Stapes Management in Tympanosclerosis
Get PDFBackground: Stapes management in tympanosclerosis has always been controversial. There are evidences supporting stapes mobilization, but there are concerns regarding refixation and recurrence of conductive hearing loss; therefore, supporting stapedectomy.Methods: In this retrospective study, clinical records, operative notes, and audiologic data of patients with stapes fixation (1994–2011) were analyzed. Audiometric findings are reported according to the recommendations of the Committee on Hearing and Equilibrium 1995 Guidelines for the Evaluation of Results of Treatment of Conductive Hearing Loss.Results: In the present study, 66 patients were enrolled (23 male, 43 female). Stapedectomy and stapes mobilization both had good hearing results (12.1 dB vs. 10.6 dB reduction in ABG) and there was no significant difference. Overall, 63.6% of patients had achieved good results (mobilization: 57.9%, stapedectomy: 71.4%). The difference in success rate between the two groups was not statistically significant.Conclusions: Stapedectomy and mobilization of stapes both seem to be efficacious and safe in the treatment of stapes involvement in tympanosclerosis. The hearing improvement is long lasting in both procedures
Prophylactic Oral Calcium Reduces Symptomatic Hypocalcemia in Patients undergoing Total or Subtotal Thyroidectomy: a Randomized Controlled Trial
Get PDFObjectives: Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy.Methods: Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups.Results: The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006).Conclusions: Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay
Early Complications Following Bipolar Hemiarthroplasty for Femoral Neck Fracture in Elderly Patients
Get PDFBackground: The femoral neck fracture is one the most important traumatic event in the elderly, because of its high rate and terrible complications. The most frequently used surgical option for the management of displaced intracapsular femoral neck fractures is the bipolar hemiarthroplasty. This study examines the incidence of early complications following bipolar hemiarthroplasty procedures for the management of femoral neck fractures using posterior approach.Methods: We retrospectively reviewed 1 year follow up of 150 patients with displaced femoral neck fracture who underwent hemiarthroplasty at our institution between 2007 and 2012. Several variables including age, sex, medical comorbidities, type of fracture, operation time, intraoperative complications, hospitalization time, surgical site infection, systemic infection, prosthesis dislocation periprosthetic fracture, pulmonary thromboembolism, mortality and Harris Hip score were examined.Results: There were 82 males and 68 females in this study. Mean age of patients was 71.4 years. There were no intraoperative mortality, however, one year follow up mortality rate was 7.33%. There were 6.66% early dislocation and surgical site infection was seen in 2.66% of patients. Venous thromboembolic events occurred in 2.66% of patients. The average HHS improved significantly at one year follow up.Conclusions: Our study showed that bipolar hemiarthroplasty through posterior approach is associated with a modest rate of complications
Single Incision Laparoscopic Surgery: Review of Pros and Cons
Get PDFDespite huge advances in minimally invasive surgeries, efforts still continue for finding less invasive methods of surgery. Patients desire less postoperative pain as well as better cosmetic outcomes. This may be achieved by decreasing the number of laparoscopic ports in which all the surgical maneuvers are performed through a single incision. However, surgeons should be also equipped to act well while avoiding adverse events of the new practicing approach. Along with increasing trends in performing of single incision laparoscopic surgery (SILS) in routine practice, the number of assessing the pros and cons of this new modality is also on the rise. Although it has been claimed that SILS is able to make the dream of invisible laparoscopy true for patients and surgeons, consecutive studies regarding postoperative outcomes questioned the benefits of the new evolved technique. Subsequent meta-analysis also revealed equal outcomes for SILS in comparison to the standard laparoscopy. Our review aimed to outline the pros and cons of SILS
Laparoscopy Versus Laparotomy in Ectopic Pregnancy
Get PDFBackground: Ectopic pregnancy (EP) is the implantation of fertilized ovum in any site of the reproductive tract except uterine cavity. To choose laparotomy or laparoscopy for treatment is based on the patient’s hemodynamic status, her past surgical history, and the physician’s experience in endoscopic surgery. The goal of this study was to compare clinical and laboratory findings in women who have undergone laparoscopy or laparotomy for EP.Methods: In this cross-sectional study, 103 women, who had undergone laparoscopic or laparotomy treatment due to EP diagnosis, were enrolled. A structured questionnaire was used to collect information. Past fertility history, past medical and drug history, clinical symptoms and signs, laboratory findings (including Hb and serum β-hCG levels), size of EP mass and its location, endometrial thickness, free fluid in pelvic or abdominal cavity, type of treatment, and method were recorded.Results: Of the study population, 58 had undergone laparotomy and 45 had undergone laparoscopy. Mean age, mass size, and B-hCG level before surgery were significantly higher in women who had undergone laparotomy. Right tubes followed by left tubes were the most affected sites. Unstable vital sign was recorded in the laparotomy group more than the laparoscopy group.Conclusions: Results of the current study showed that women who had undergone laparotomy had significantly higher mean age, mass size, and B-hCG level and were more unstable than the laparoscopic group
