Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Right-sided Diaphragmatic Eventration: A Case Report
Get PDFBackground: Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of diaphragm resulting diaphragmatic elevation. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm.Case Report: A 62-year-old man presented with complaints of chronic abdominal pain and dyspnea. In recent months, he suffered from an exertional dyspnea. With the radiological investigations, a diagnosis of eventration of right diaphragm was made and the diaphragmatic plication was done.Conclusions: Complete eventration of diaphragm invariably occurs on the left side; but partial eventration of diaphragm occurs virtually on the right side, and is diagnosed based on different radiologic findings. In this case, complete eventration of diaphragm was seen on the right side which is a rarity
Objective Assessment of Skin Defect in Syndactyly Repair
Get PDFBackground: Syndactyly, as one of the most common congenital hand abnormalities, requires surgical repair according to various approaches.Case Report: We report a 28-year-old man with simple syndactyly in his third web.Conclusions: The common concern is about skin defect coverage, and we illustrated in a mathematical objective survey, if distance between to phalanxes’ center was more than 1.5 times diameter (each of phalanxes), then there would not necessary to use skin graft
Biological Optimization of Cortical Bone Allografts: A Study on the Effects of Mesenchymal Stem Cells and Partial Demineralization and Laser Perforation
Get PDFBackground: Despite promising results have shown by osteogenic cell-based demineralized bone matrix composites, they need to be optimized for grafts that act as structural frameworks in load-bearing defects. The purpose of this experiment is to determine the effect of bone marrow mesenchymal stem cells seeding on partially demineralized laser-perforated (DLP) structural allografts that have been implanted in critical femoral defects.Methods: Thirty-two Wistar rats were divided into four groups according to the type of structural bone allograft; the first: partially demineralized only (Donly), the second: partially demineralized stem cell seeded (DST), the third: partially DLP, and the fourth: partially demineralized laser-perforated and stem cell seeded (DLPST). Trans-cortical holes were achieved in four rows of three holes approximated cylindrical holes 0.5 mm in diameter, with centers 2.5 mm apart. P3 mesenchymal stromal cells (MSCs) were used for graft seeding. Histologic and histomorphometric analysis was performed at 12 weeks.Results: DLP grafts had the highest woven bone formation, where most parts of laser pores were completely healed by woven bone. DST and DLPST grafts surfaces had extra vessel-ingrowth-like porosities. Furthermore, in the DLPST grafts, a distinct bone formation at the interfaces was noted.Conclusions:This study indicated that surface changes induced by laser perforation, accelerated angiogenesis induction by MSCs, which resulted in endochondral bone formation at the interface. Despite non-optimal results, stem cells showed a tendency to improve osteochondrogenesis, and the process might have improved if they could have been supplemented with the proper stipulations
Symptomatic Müllerian Duct Cyst in a Male Adult: A Rare Case Report
Get PDFBackground: Müllerian duct cyst is an uncommon congenital anomaly. It is usually small and asymptomatic. A rare case of this entity with symptoms of ejaculatory duct obstruction such as hematospermia and secondary infertility is presented here.Case Report: A 39-year-old male presented with complaints of pain in the lower abdomen, dysuria, frequency, and hematospermia for the last 2 years. He also suffered from secondary infertility with a 9-year-old son. Imaging studies showed a large cystic midline lesion right behind the bladder and also bilateral dilated ejaculatory ducts. The patient underwent a transurethral drainage. The prostatic urethra was resected using a 26 Fr resection loop proximal to the verumontanum and a capacious cystic structure opened, and finally two dilated ejaculatory duct openings were seen. On follow-up, a significant improvement of symptoms and semen quality was achieved after surgery.Conclusions: A high index of suspicion in using advanced imaging modalities is necessary for the diagnosis of this anomaly. Surgical excision of a Müllerian duct cyst may be performed depending on the size and location of the cyst and the presence of clinical symptoms. Transurethral de-roofing of the cyst is effective and safe for the treatment of small Müllerian duct cyst accompanied with ejaculatory duct obstruction
Effect of Intravenous Paracetamol on Acute Post-operative Pain, Nausea, and Vomiting after Outpatient Diagnostic Laparoscopy for Infertility
Get PDFBackground: Post-operative pain, nausea, and vomiting (PONV) are significant causes of morbidity among patients undergoing outpatient diagnostic laparoscopy. However, the optimal strategy for prevention of these side effects remains unclear. Many drugs and their combination have been used to attenuate these adverse responses. We conducted a study to evaluate the effect of intravenous (IV) paracetamol on attenuation of acute post-operative pain and opioid consumption and as a result PONV at the same time in infertile women undergoing diagnostic laparoscopy.Methods: A total of 104 American Society of Anesthesiologists Class I-II infertile women aged 18-40 years, who were scheduled for elective diagnostic laparoscopy under general anesthesia, were included and anesthetized with the same technique. The paracetamol group received IV infusion of 1000 mg paracetamol in 100 ml saline, and the placebo group received the same volume of saline after induction of anesthesia. Pain score at the end of surgery and 1 hour later, PONV and fentanyl consumption as rescue analgesic at the recovery room were all recorded and compared between the two groups.Results: There were no significant differences between the two groups regarding demographic data. Mean pain score was 2.8 ± 2.7 in paracetamol group and 4.3 ± 3.5 in placebo group at the end of surgery (P = 0.016). Mean pain score was 3.7 ± 2.1 in paracetamol group and 4.6 ± 2.2 in placebo group 1 hour after surgery (P = 0.030). Nearly 36% of patients in placebo group and 14% in paracetamol group need additional fentanyl for pain relief after surgery (P = 0.008). Incidence of post-operative nausea was 16.3% and 14.5% in placebo and paracetamol groups, respectively, (P = 0.150). Incidence of post-operative vomiting was 6% and 0 in placebo and paracetamol groups, respectively, (P = 0.040).Conclusions: IV paracetamol reduced post-operative pain and nausea in infertile women undergoing diagnostic laparoscopy for assisted reproductive techniques
Giant Solitary Fibrous Tumor of the Liver, Case Report: Unusual Site, Extravagant Presentation, Aggressive Behavior
Get PDFBackground: Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal tumor. It can originate from abdominal soft tissue which is extremely scarce, and liver indeed is super scant site. SFT liver (SFTL) is mostly benign, but it can be malignant and aggressive with metastases and a potential of recurrence. Hypoglycemia is the least reported feature which is resistant to medical management and will be resolved following resection of a SFT of liver.Case Report: A 67-year-old man presented with episodes of sudden onset loss of consciousness since 3 months before first visit. He was a previously healthy farmer, without any other complaint or past medical history except for episodes of sever hypoglycemia. Laboratory testing revealed hypoglycemia which was temporarily response to glucose infusion, hypoglycemia was refractive, and whole physical examination and laboratory tests were done and there were no abnormal findings. With probability of finding something such as insulinoma or any other tumor that secreted insulin or insulin-like growth factors, a magnetic resonance imaging (MRI) was performed and revealed an enhancing giant round and well-defined lesion in left lobe of live.Conclusions: We here present the first case of malignant SFTL presenting with hypoglycemia and metastasis to soft tissue as inguinal bulging 2 months after resection of liver mass, but this particular type of tumor needs more evaluation and investigation
Predicting Factors for the Communication between hydatid Cyst and Biliary Tract
Get PDFBackground: Hydatid cyst communicated with biliary tract increases the morbidity and mortality rates. Therefore, early detection and treatment are vital.Methods: From 96 patients undergone hydatid cyst surgery, 12 were excluded. The specifications, size, location, and position of the cyst, the condition of the cyst wall thickness, the caught lobe, cyst rupture, liver abscess, and the size of the inside and outside liver bile ducts were identified through computed tomography scanning. Age, gender, icterus, white blood cell (WBC) count, the total, direct, and indirect bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase were identified.Results: In 21 patients (13 men and 8 women), there was communication between the hydatid cyst and biliary tract; from them, 14 patients had icterus. There were significant differences between the size of the cyst, the levels of liver enzymes, bilirubin, and alkaline phosphatase, and WBC count in communicated and non-communicated hydatid cysts (P = 0.001). There were no significant differences between the two groups in terms of age, gender, location of the cysts in the liver, and the thickness of the liver.Conclusions: Only the cyst size and the level of bilirubin were the predicting factor for the communication between hydatid cyst and biliary tract
Evaluation of Early Removal of Urinary Catheter after Rectal Cancer Surgery
Get PDFBackground: It is a common practice to catheterize the bladder during major surgical procedure and leave the catheter in situ to avoid post-operative urinary complications such as retention or incontinence. Catheter removal on post-operative day 5 is a routine, and it causes some urinary problems and longer hospital stay. The objective of this study was to evaluate the effect of early removal of urinary catheter on the 1st day after rectal cancer surgery, on the rate of urinary complications.Methods: This quasi-experimental study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Iran. 80 patients with rectal cancer underwent surgery at Imam Hossein Hospital from 2015 to 2016, were recruited with planned early removal of urinary catheter after surgery. Personal and disease information was recorded in all patients after obtaining the informed consent. Urinary complications were checked by the surgical resident after the operation.Results: Mean age of participants was 56.64 ± 14.90 (range: 22-84 years). From these patients 46 (57.5%) were male, and 34 (42.5%) were female. Two cases (2.5%) were manifested urinary problems in men. One of them reported urinary retention and the other one had hematuria. Both patients were in Stage III of rectal cancer and had laparoscopic surgery. Urinary incontinence was not reported in any patients.Conclusions: In patients who undergoing rectal cancer surgery, urinary catheter can be removed on the 1st post-operative day without any significant increase in urinary complications
Evaluation of Pre- and Post-operative Hemoglobin in Patients with Maxillofacial Injuries
Get PDFBackground: In the past decades, a significant increase has been observed in head and face traumas bleeding during and after surgery is one of the most important and dangerous factors for patients. This study was performed to assess the bleeding amount in patients during maxillofacial surgeries and the necessity of blood transfusion.Methods: In this cross-sectional study, 441 patients were enrolled, of which 83.2% and 16.8% were male and female, respectively. To compare the patients’ mean hemoglobin concentration before and after surgery, paired t-test was used. Furthermore, to compare the mean hemoglobin concentration and mean intraoperative bleeding between males and females, independent t-test was used. The significance level was set as 0.05 for all tests.Results: Results showed that the mean difference of hemoglobin concentration before and after surgery in patients of the study had a significant difference (P < 0.001). The amount of blood loss during surgery showed no significant difference between males and females (P > 0.050).Conclusions: The results of this study demonstrated that there was a decrease in mean hemoglobin concentration after surgery, and also, the amount of blood loss in patients during surgery was not high enough for blood transfusion. However, it should be considered that to prevent any problem during surgery, assessing patients with anemia before surgical operations is necessary
The Effect of Different Combination Doses of Intrathecal Hyperbaric Bupivacaine 0.5% and Sufentanil on the Hemodynamic Profile of Geriatric Patients Undergoing Hip Surgery under Spinal Anesthesia
Get PDFBackground: With the increasing number of elderly patients with fragile hemodynamic profiles undergoing lower limb surgery, avoiding hypotension in this population is of great importance. We intended to study the effect of different combination doses of intrathecal hyperbaric bupivacaine 0.5% and sufentanil on the hemodynamic profile of geriatric patients undergoing lower limb surgery.Methods: A total of 60 patients aged over 70, candidates for lower limb surgery under spinal anesthesia were enrolled in this study. The patients were randomly allocated into three groups. Group 1 (G1: 5 mg bupivacaine plus 10 µg sufentanil intrathecally), Group 2 (G2: 10 mg bupivacaine plus 5 µg sufentanil intrathecally), and Group 3 (G3: 15 mg bupivacaine intrathecally). Non-invasive automated blood pressure was checked every 1 minute for the first 5 minutes, and every 5 minutes for 25 minutes and every 15 minutes for 30 minutes during surgery. Heart rate (HR) was recorded at the same intervals. The quality of the blocks was also compared.Results: A total of 60 patients met the inclusion criteria and were enrolled in the study. Five patients had failed spinal anesthesia whom were replaced with new patients. There was no difference between the groups in their baseline characteristics. Mean arterial pressure after 1 minute in Groups 2 and 3 was significantly lower than Group 1 (86.0 ± 9.0, 87.3 ± 11.0, 92.2 ± 13.0, P = 0.001). No statistically significant difference in HR was observed in between the three groups. The degree of motor and sensory block was adequate in all three groups, and no patients required any additional analgesics. 15 (75%) patients in Group 3 received ephedrine in comparison to 11 (55%) patients in Group 2. 3 (15%) patients in group one needed ephedrine.Conclusions: In conclusion, adding sufentanil as an adjuvant and decreasing the dose of intrathecal hyperbaric bupivacaine may help maintain a stable hemodynamic during lower limb surgery in the elderly