نشریه جراحی ایران
سال بیست و یکم شماره 4 (زمستان 1392)

The American Cancer Society has announced that approximately 200،000 women are diagnosed with breast cancer annually. Among which %1-%7 are diagnosed with the most invasive breast cancer type; the Inflammatory Breast Cancer. In Iran، breast cancer is the commonest cancer among women comprising 21. 4% of all cancers among females. Environmental factors and genetic susceptibility play an important role in causing breast cancer. The environmental factors include: aging، and socioeconomic status and the genetic factors include: race، mutation and repetition. Some inflammatory breast cancers are the invasive ductile type. The diagnosis of this particular breast cancer is specifically determined clinically. Sonography، MRI، PET/CT and Mammography are common ways to diagnose this type of breast cancer. They provide us with specific information in regards to inflammatory breast cancer. Generally inflammatory breast cancer is fatal but recent improvement in therapeutic approach like Pre-Surgical Chemotherapy has significantly increased the survival rate.

Introduction & The thirteenth most common cause of death in the Western world is ruptured abdominal aortic aneurysm. Although considerable researches have been done about to the etiology and mechanism of aneurysm expansion، little is known about the mechanism of rupture. The aim of this study was to evaluate the possible role of helicobacterpylori and chlamydia pneumoniae and mycoplasma pneumoniae in the expansion and rupture of abdominal aorta aneurysm. In this cross sectional study، we evaluated 50 patients with abdominal aorta aneurysm، in a period of 2 years at our hospital. Four patients with a history of dyspepsia and anti-Helicobacter pylori therapy or a recent history of upper respiratory infection were excluded from our study. Patients were divided into two groups، based on the indication for aneurysm surgery. The first group had undergone elective abdominal aortic aneurysm surgery and the second group had undergone emergency surgery of ruptured aortic aneurysm. During surgery، was performed sampling of the aneurysm wall was done. Samples were immediately transported to the laboratory to have the extraction of DNA of microbes by PCR. In this study، 46 patients were evaluated. In both groups، helicobacterpylori DNA and mycoplasma pneumoniae DNA weren’t detected. But the highest rates of Chlamydia pneumoniae DNA was detected in patients with ruptured abdominal aortic aneurysm (P

Introduction & Facial skeletal growth and development could be asymmetrical between the two sides of the face. This deformity has influence on all structures، including ULC of the nose، its thickness، elasticity، and shape. Considering this anomaly in crooked nose patients and try to correct it، may have a positive effect on our surgical result. Eighty nine rhinoplasty patient’s chart were reviewed for middle vault asymmetries and surgical procedures performed for each case were reviewed. Asymmetric upper lateral cartilages were observed in 81% of cases (72 cases)، and 30% of total cases had straight septum with asymmetrical upper lateral cartilages (27 cases) which needed some intervention. The crucial point in correcting crooked nose is to keep in mind the upper lateral cartilages deformities and trying to make them more symmetrical by septal straightening. This is effective in preventing the recurrence of the problem after surgery.

Introduction & Tibial shaft open fractures are the most common long bone fractures and are prone to complications such as infection. Tibial open fracture is one of the orthopedic urgencies. Standard surgical technique for the management of this problem is fixation and surgical debridement within the first 6 hours. But appropriate time for the debridement is not agreed upon. We aimed to evaluate the role of delayed surgical management in prevalencies of infection in open tibial fractures. The 92 patients with open tibilal fractures who were candidate for surgical management in the orthopedic ward of the university hospital، from 2008 to 2013، enrolled in this cross sectional descriptive prospective study. Analysis was done by SPSS 16. Patient were divided into 4 groups according to the average period of time from the damage (tibial fracture) to the time of surgery (0-6، 6-12-، 12-24 and more than 24 hours). The severity of injury was classified based on Gastilo criteria. The number of patients with infection was determined and compared in each group by chi2 test and fisher exact test. No increase in infection was seen in operation time delay. Infection had occurred in 7، but five of the underwent the operation during the first six hours after injury. One person was in 6-12 hours group and the management (operation) was done in one patient later than 24 hours after injury. There were direct correlation the between severity of injury، ime interval between gustillo type and infection. The prevalence of infection is related to severity of injury more than the of injury and surgical operation. So surgery can be delayed to a suitable situation.

Introduction & There is a challenge over the treatment of giant pulmonary hydatid cysts. Therefore، we aimed at comparing the surgical procedures and postoperative complications between patients with giant and non-giant hydatid cysts. In a retrospective clinical study، patients operated for hydatid lung cysts were divided into giant pulmonary hydatid cysts (size >10 cm) and non-giant hydatid cysts groups. Patients were treated surgically using lung preservation (capitonnage، uncapitonnage and segmentectomy) and lobectomy procedures. A total of 612 patients، 59 (9. 6%) in the giant and 553 (90. 4%) in the non-giant pulmonary hydatid cysts، were recruited. The most common symptoms in the giant group were cough 59 (100%) and dyspnea 42 (71. 2%). These symptoms along with the systemic symptoms and ruptured hydatid cysts were more observed in the giant group (P

Introduction & There is common view that the appropriate therapy for pilonidal abscess is simple incision and drainage. Our study aimed to investigate the surgical outcomes of limberg flap among patients with pilonidal abscess and its comparison with the cases of pilonidal sinus. We studied patients with pilonidal sinus and pilonidal abscess to evaluate the results of surgery، postoperative outcomes and further complications along with the recurrence rate. Hence، 81 patients were enrolled in our study from 2008 to 2011. All the patients were treated by limberg flap. Of 81 patients with pilonidal disease، 60 patients had only sinus while 21 cases developed infected abscess. In the sinus group، 2 cases (2. 4%) developed hematoma، 3 cases (5%) surgical site infections، and 12 (15%) surgical site numbness. In the abscess group، 2 of the cases (9. 5%) had surgical site infection and 4 cases (19%) developed numbness. Performing Limberg flap procedure for the case of patients with pilonidal abscess leads to the same results as the case of patients with pilonidal sinus.

Introduction & The relationship between the delay in the diagnosis of acute appendicitis and the risk of perforation is not clear yet. The aim of this study is the reviewing of appendectomy cases in order to determine the incidence of perforation due to the delay in the diagnosis. Records of 508 patients who were operated on for acute appendicitis between years 2010-2012 in Shahid Beheshti hospital of Kashan were reviewed. Data gathered included age at the time of operation، gender، kind of appendicitis، duration of symptoms before diagnosis. Finally، the obtained data were entered into SPSS 16 software and were analyzed by using chi square، Fisher''s exact test. Out of 508 patients، 128 (25. 2%) had perforated appendicitis. The perforation rate in patients without diagnostic delay was 28. 9%، and in patients with diagnostic delay was 14. 1%. This difference was statistically significant)P-value

Introduction & Surgeons are one of the high-risk groups who are at the risk of injury from sharp objects at their workplace. This study was aimed to determine the prevalence and reporting rates of needle-stick injury amongst surgeons affiliated to Kermanshah University of Medical Sciences during 6 months of 2012. In a cross-sectional descriptive-analytic study، 29 surgeons were recruited for this study by the census sampling method. A valid and reliable questionnaire was used for data collection. Data was analyzed by using SPSS-16 software and descriptive and analytic statistics including Chi-squared test and Mann-Whitney U. Of the 29 selected surgeons، 5 (17. 2%) had a needle-stick injury during the last 6 months. Only 1 of the 5 (20%) who has suffered from a needle-stick injury، had followed the established confined plan. The most common cause of needle stick injuries was suture needle (60%). There were a statistically significant differences between needle-stick injury and sex (P=0. 003، X2=5. 612)، the numbers of patients (Z=2. 40، P=0. 016) and the amount of working hours per day (Z=2. 85، P=0. 004) in both injured and non injured groups. Considering the relatively high prevalence of needle-stick injury among the surgeons and their neglect of reporting and tracking this issue، it is recommended that needle stick protocols should be completely adhered to in the operating rooms. The tools used for operation should be safe and less risky.

Introduction & Trauma is the most common cause of death during the first three decades of life. Chest trauma apply for 10 to 30% of all traumas and is responsible for 25% of death in trauma patients. Present study was done with the aim of assessing epidemiologic features of chest traumas in admitted to Hamedan Beasat hospital، during 2008-2009. In this descriptive retrospective study all patients with chest trauma who had referred to this hospital during years 2008 and 2009 were assessed. Data collection was done by obtaining information from dossiers and registering them in data collection forms. In the present study 568 patients were assessed. The mean age of these patients was 36. 70±17. 58 years، the minimum age was 5 years and the maximum age was 98 years. Most of these patients were male (87. 3%)، and the majority of them (76. 8%) were living in cities; 68. 5% of the patients were married، and 40. 7% of patients were smoking cigarette and 8. 8% of them were using narcotics. Only one patient (0. 2%) was using alcohol. In 59. 5% of the cases، the type of trauma was non-penetrating. In most cases cause of injury was motor vehicle accident (43. 8%). 5. 6% of patients died. The mean age of the dead patients (61. 53 ± 22. 66 years) was significantly higher than other patients (35. 30 ± 16. 10 years) (P = 0. 000). The cause of death was hypovolemic shock، with respiratory failure in 50% of the cases. The results of the present study showed that motor vehicle accident was the most common cause of injury in the studied patients. The most common cause of death was hypovolemic shock، with respiratory failure and it was mostly seen in older patients.

Thymolipoma is a very rare benign neoplasm of the thymus. We present the case of a 34-year-old female with a massive mediastinal tumor discovered on a chest X-ray after a car accident. The patient had no complaints and her physical examination was unremarkable. Chest CT scans revealed a lipomatous mass containing areas of soft tissue density in the anterior mediastinum. After discovering the mediastinal mass، patient was asked about any related symptom، and she mentioned just chest discomfort، which she did not consider it as a problem and so did not visit a physician. CT guided biopsy of the mass revealed thymic tissue associated with a prominent fatty component. The patient was submitted to median sternotomy، which resulted in the complete excision of the tumor. The pathological diagnosis was thymolipoma with degenerative changes. Thymolipoma usually attains enormous dimensions by the time of diagnosis، are usually asymptomatic، and the occasional symptoms are related to the compression of adjacent structures. Surgical resection is the treatment of choice and offers the only possibility of cure.

A 43 years old woman was admitted، complaining from cough and bloody sputum. In the chest radiography and pulmonary CT scan، perforated hydatid cyst was reported. Because the patient was asymptomatic and because radiography indicated that cysts were drained spontaneously، non-surgical treatment was recommended. This treatment included the administration of albendazole 400 mg twice daily. Patient did not develop any symptoms and no radiological changes in the first 18 months follow up.