Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Comparing the Effect of Eutectic Mixture of Lidocaine and Prilocaine and Capsaicin on Improving Ischemic Random Skin Flaps: An Animal Model
Get PDFBackground: Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.Methods: A number of 39 white-albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.Results: The mean values of necrosis in the flaps were 603.33 ± 116.00 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).Conclusions: EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards
The Effect of Informing Parents or Caregivers of Patients on Their Anxiety from Anesthesia Risks during Their Child’s Surgery
Get PDFBackground: Each patient who needs a surgical operation is going under general anesthesia with many risks. The purpose of this investigation was to determine whether the provision of detailed anesthetic risk information is associated with increased parental anxiety.Methods: In this randomized clinical trial study 140 caregivers of patients admitted for surgery, was selected in order of their reference and they were asked to fulfill the test. In the next step, persons were distributed into two groups of the control group with an even number and the intervention group with odd number (according to the numbers on questionnaire). The routine information about the risks of anesthesia was given to the control group with an even number at the operation date in holding area, and they were asked to re-fulfill the questionnaire.Results: The majority of parents (> 95%) preferred to have comprehensive information concerning their child’s perioperative period, including information about all possible complications. For selected items, increased parental educational level was associated with increased desire for information (P < 0.050). For Phase 2, when the intervention group was compared with the control group, there were no significant differences in parental anxiety over the 4 time points [F(1,45) = 0.6, P = 0.410]. Furthermore, the interaction between time and group assignment was not significant [F(3,135) = 1.66, P = 0.181].Conclusions: We conclude that parents of children undergoing surgery desire comprehensive perioperative information. Moreover, when provided with highly detailed anesthetic risk information, the parental anxiety level did not increase
Primary Mediastinal Synovial Sarcoma: A Rare Case Report
Get PDFBackground: Synovial sarcomas commonly occur in the extremities of young adults. A primary occurrence in the mediastinum is very rare with only a few reported cases in the world literature.Case Report: This paper is about a 47-year-old male who presented with retrosternal chest pain and shortness of breath on exertion. Imaging showed an anterior mediastinal mass. Pathological examination of the resected mass showed a biphasic neoplasm with a spindle cell component admixed with gland-like elements. The tumor showed positive staining with cytokeratin, epithelial membrane antigen, and vimentin confirming the diagnosis of a biphasic synovial sarcoma.Conclusions: A wide range of neoplasms, both primary and metastatic, occurs in the mediastinum, which poses considerable diagnostic difficulties. A synovial sarcoma should always be considered in the differential diagnosis, and immunohistochemistry is an important adjuvant tool in this situation. This paper highlights the importance of recognizing an unusual presentation of this aggressive neoplasm to aid appropriate clinical management
Intratympanic Dexamethasone Delivery versus Placebo in Intractable Meniere Disease
Get PDFBackground: Numerous treatments strategies were used for Meniere disease (MD). In this study, we aimed to compare the efficacy of intratympanic dexamethasone versus intratympanic placebo in intractable MD.Methods: This was a single-blinded randomized clinical trial. All patients with Intractable MD underwent ventilation tube insertion into tympanic membrane and were randomly allocated to two groups of 18-patients. The patients of the first group used dexamethasone base drop (placebo) every other day, the second group used dexamethasone drop for 3 months, and all patients were followed for 12 months.Results: Control of vertigo and tinnitus with dexamethasone was more than the placebo, but there was no statistically significance difference between two groups (P > 0.05). Hearing function improvement and aural fullness resolution were higher in the placebo group, but there was no statistically significance difference, too (P > 0.05). Vertigo control in dexamethasone group in our study ranged from 72.2% to 83.3% of patients at different intervals. These figures ranged from 66.6% to 83.3% in placebo group. The highest rate of hearing function improvement in our study was 27.7% in placebo group. Tinnitus also followed the same pattern as hearing function.Conclusions: Intratympanic dexamethasone for MD is very satisfactory if medical treatment fails with good vertigo control and no risk to hearing
The Effect of Ticlopidine on Early Arteriovenous Fistula Thrombosis: A Randomized Clinical Trial
Get PDFBackground: Arteriovenous (AV) fistula is the first choice of a long-term vascular access for hemodialysis, but there is a 20-30% probability of thrombosis in the 1st month after its creation. Ticlopidine is a potent drug, which inhibits both primary and secondary platelet aggregation. This study is performed to evaluate the effect of ticlopidine in the prevention of AV fistula.Methods: Totally 124 patients in need of an AV fistula were divided into two groups after creation of their fistula. In the first group, we prescribed ticlopidine for 62 patients, and in the second group, 62 patients received placebo. The two groups were compared to see if their fistulas are patent or thrombotic after 1 and 3 months.Results: Of the 62 patients who received ticlopidine, four had fistula thrombosis, while in 62 patients who received placebo, 16 had fistula thrombosis (P = 0.003). This shows the significant effect of ticlopidine in the prevention of thrombosis in AV fistulas. Also, we compared age, sex, and the fistula location in the ticlopidine and placebo groups, and these attributes had no significant difference between the two groups (P > 0.050).Conclusions: Considering the significant value of ticlopidine in the prevention of AV fistula thrombosis, it can be recommended after the surgery if there is no contraindication for its use
Coronary Artery Bypass Grafting: Simultaneous Head and Neck Mass Surgery
Get PDFBackground: Coronary artery disease (CAD) and cancer have common risk factors. According to the necessity of mass resection in patients with CAD at the same time, we decided to do neck and head mass resection and coronary artery bypass grafting (CABG) simultaneously and assess the results.Methods: The current study was done on patients who were candidates for simultaneous head and neck mass resection and CABG. The patients’ files were extracted, the information and complications were recorded in a questionnaire, and then necessary data were extracted.Results: Totally 9 patients (3 females and 6 males) with a mean age of 69.11 ± 6.67 standard deviation years were studied. The most common site of squamous cell carcinoma in this study was tongue. Infection occurred in three patients, two of which (66.66%) died. Side effects occurred in four patients.Conclusions: It seems that, according to the anatomical position of neck mass, proximity to the airways and large blood supply in that area, and also because of inappropriate access to the anatomical zones, the survival rate and complications in this surgical setting (simultaneous surgeries) are different from that of other studies. It seems that further studies are needed to be done with the subject of concomitant head and neck mass surgery and CABG this time with a larger number of patients
Plethysmography Variability Index as a Guidance for Intraoperative Fluid Management in Cesarean Section Delivery under Spinal Anesthesia: A Pilot Study
Get PDFBackground: Plethysmography variability index (PVI) is a measure of the dynamic changes in the perfusion index (PI) that occur during one or more complete respiratory cycles. This study was designed to investigate the accuracy of PVI in guidance of fluid management in parturient undergoing cesarean section surgery under spinal anesthesia.Methods: This randomized clinical trial was performed on 21 consecutive patients who were candidate for cesarean section surgery under spinal anesthesia at Shariati Hospital in Tehran, Iran, between April 2015 and April 2016. The patients were randomly assigned to one of the PVI or conventional group. In all patients, serum level of lactate, mean arterial pressure (MAP), total amount of infused intraoperative fluids, urine output, and duration of surgery were recorded.Results: In total, 21 patients (10 in PVI group and 11 in control group) were assessed. The trend of the change in MAP was significantly different between the two groups with a downward trend in PVI group and a fluctuated trend in the conventional group (P = 0.003). The mean amount of infused fluid was 2565.00 ± 563.74 ml in PVI group that was significantly lower than control group (3122.73 ± 321.99 ml) (P = 0.011). Although urine output was numerically higher in PVI than in control group (425.00 ± 274.12 ml vs. 322.00 ± 121.82 ml), it was not statistically significant (P = 0.292). In PVI group, the primary value of PVI was 23.80 ± 6.93 that reached to 12.20 ± 1.75 at the end of surgery indicating a significant reduction (P < 0.001).Conclusions: Regarding clinical and hemodynamic stability as well as fluid therapy responsiveness (less requiring fluids within surgery), PVI monitoring seems to be superior to the conventional method
International Students Seeking Medical Education in Iran; Challenges and Opportunities
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Investigating Long-term Outcomes of Surgical Treatment in Spinal Tumors: A 10 years Follow-up Study
Get PDFBackground: Spinal tumors account for 10-15% of total central nervous system neoplasms. This study presents the results of surgical procedures performed on a significant number of patients with spinal tumors.Methods: The present article presents results of surgery performed on 104 of 204 patients with spinal cord tumors referred to the hospital clinic where they underwent the operation from 2005 to 2015. The studied cases included age, sex, and duration of the disease, and clinical symptoms and their time of occurrence, place of birth, radiological characteristics, surgical results, surgical resection, tumor histology, and complications. In addition, the results are compared with other studies.Results: A total of 104 studied subjects who underwent the surgery 50% were male. The mean age of patients was 37.1 years. The most common site of the tumor was the thoracic (30.8%) and cervical regions (27.9%). Extramedullary and intramedullary tumors accounted for 74.1% and 25.7% of cases, respectively. Among the extramedullary masses, the most common pathology was nerve plexus tumor (58.4%) and then meningium (18.2%). Astrocytoma (55.6%) and epandiomy (25.9%) were, respectively, the most common types of intramedullary tumors. The total or almost total resection was performed in 78.9 of cases. The average follow-up time was 29 months. The post-operative neurological status of patients was improved in 84.6% of cases.Conclusions: The factors affecting on the final state of the patients after the operation include the degree of malignancy, the extent of the lesion and the pre-operative severity of the neural defect