Journal of Surgery and Trauma
Volume:6 Issue: 4, Winter 2018

On September 2018, a case report titled “Squamous cell carcinoma arising from a sebaceous cyst” was published in the “Journal of Surgery and Trauma” (volume 6, issue 2) (1). It was an interesting article; however, I think when dealing about such rare tumors, it is important to be aware of other diseases, such as proliferating trichilemmal cysts (PTC) that may be confused with squamous cell carcinoma arising from a cyst. Trichilemmal (pilar) cysts are common in the scalp. These cysts originate from the outer root sheath of the hair follicles. Although trichilemmal cysts are benign, they can be transformed to PTC as a result of trauma and inflammation (2). The PTCs appear as intradermal masses with a size range of 1-10 cm. They may affect the overlying skin through fistulization or leave it intact. There are some reports regarding PTCs as fungating tumors with a diameter of 25 cm (3, 4). The PTCs can also have an invasive and malignant behavior, and therefore be called malignant PTCs (MPTCs). The MPTCs are reported to be accompanied with local invasion, metastasis to the lymph nodes, and distant metastases (5). Treatment of benign PTC involves a simple excision; however, the management of MPTCs requires surgical procedures with a safe excision margin of 1 cm (6, 7). Mohs micrographic surgery may increase the chance of the complete removal of the tumor (8). In addition to the excision of the tumor with a wide margin, other therapeutic modalities, such​as lymph node dissection, radiotherapy, and chemotherapy, should be also considered for the treatment of MPTC (3, 8-10). In metastatic cases resistant to the above therapies, ethanol injection into the lesions has been used to control the disease (11).

  Discharge planning (i.e., discharge education and telephone follow-up) decrease the readmission rate to the hospital and increase patient’s satisfaction. Orthopedic patients, especially after the surgery have many problems. Therefore, discharge planning for this group of patients is significant. This study aimed to compare discharge education and telephone follow-up on the satisfaction and readmission of patients after orthopedic surgery. This quasi-experimental study was performed on 150 patients divided into three groups before and after the intervention. The patients in the discharge education group were involved in both routine intervention in the ward and a designed discharge planning program based on the study at discharge time. The subjects in the telephone group were involved in the routine intervention in the ward and followed up for 4 weeks by telephone call (3-4 times) at homes. The cases in the control group were involved only in routine intervention in the ward. The satisfaction level was measured by standard satisfaction questionnaire. The readmission rate of the patients was recorded a month after discharge. The data were analyzed using SPSS software (version 19). In addition, paired t-test, Chi-square test, and one-way analysis of variance were used to compare the mean scores of satisfaction before and after the intervention among the three groups. P-value less than 0.05 was considered statistically significant. The obtained results showed that after the intervention, the mean score of satisfaction among the three groups was considered statistically significant (F=58.69, P<0.001). The mean scores of satisfaction in the instruction and telephone follow-up groups were significantly higher than that of the control group (P<0.001). Out of 150 participants in the present study, 10.6% of them were readmitted. Discharge education or telephone follow-up as a target processor can be an effective step in the improvement of patients' conditions, satisfaction increase, and reduction of the patients’ readmission rate

  There is insufficient information about the correlation between hearing and visual impairments. Its importance arises when trainers should care about medical issues of their clients. Refractive errors of the eye are one of the main causes of visual loss in the society. The purpose of this study was to evaluate the relationship between refractive errors in the eye (by the type of refractive error) and hearing loss in patients referred to Vali-e-Asr Hospital in Birjand, Iran. In this case-control study was conducted on 124 patients referring to Ear, Nose, and Throat Clinic with hearing loss (case) and 117 patients with normal hearing status (control). The participants were selected non-randomly and they were matched in terms of age and gender. All data were analyzed by SPSS (version 21) using the Chi-square test and t-test. P-value less than 0.05 was considered statistically significant. A total number of 241 patients (case=124, control=117) participated in this study. There were 51.6% and 54.7% of women in the case and control groups, respectively. The mean ages in the case and control groups were 36.03±17.13 and 35.95±18.22 years, respectively. The frequencies of refractive disorders were similar in both groups (i.e., 36.3% in case vs. 38.5% in control). The frequencies of myopia in the case and control groups were 85% versus 72.5% for the right eye and 88.4% versus 75.6% for the left eye. There was the higher prevalence of myopia in the case group; however, the relationship was not significant. The results showed that the difference in the prevalence of refractive errors in the hearing loss of patients was not statistically significant, compared to patients with normal hearing. There was no significant difference between the hearing loss and refractive disorders. Individuals with hearing loss showed higher prevalence of myopia; however, the relationship was not statistically significant

  Presbyopia and presbycusis are common disorders in aging people leading to various negative consequences, such as social problems, cognitive disorders, depression, and imbalance. The combination of vision and hearing loss has been correlated with various adverse outcomes. Regarding the adverse effect of presbyopia and presbycusis on communication skills and quality of life in individuals, this study was conducted to determine the relationship between these two sensory disorders. This cross-sectional study was performed on 111 patients with presbyopia referred to Ophthalmology Clinic of Vali-e-Asr Hospital in Birjand, Iran, from 1395 to 1396. The patients who met reduced visual acuity criteria were included in the study. On the other hand, the exclusion criteria were: 1) diabetes, 2) glaucoma, 3) ear infection disease, 4) kidney disease, 5) history of head injury, 6) history of ototoxicity, 7) history of ear and intracranial tumors, and 8) experience of working in noisy environments. Presbyopia and presbycusis were diagnosed with routine clinical examinations.
The data were analyzed in SPSS software (Version 22.0) using the Chi-square, Fisher's exact, and Mann-Whitney U tests. P-value less than 0.05 was considered statistically significant. The results of the study showed that 70%, 64%, and 55% of the patients in the age ranges of 45-49, 50-55, and 56-60 years old, respectively, had different visual problems. In the present study, slight hearing impairment was observed in individuals. No correlation was observed between presbyopia and presbycusis in terms of gender and place of residence (i.e., urban, rural). Moreover, there was no relationship regarding these two sensory impairments. (P<0.05). There was no relationship between presbyopia and presbycusis. The incidence of presbyopia was more than 50% and mild hearing impairment was observed in patients. In addition, the treatment of these disorders can prevent adverse consequences, such as cognitive impairment and falling down

The aim of this study was to investigate the improvements of central serous chorioretinopathy (CSC) treated with topical dorzolamide. These observational case studies included nine eyes of the nine patients with CSC, treated by a physician with topical dorzolamide consecutively over a one-month period. The central macular thickness and best-corrected visual acuity (BCVA) were measured and compared with baseline values. All the eyes of nine patients demonstrated subretinal fluid (SRF) before or during the treatment course. The SRF was measured and compared with baseline values in this subgroup. Among the cases (n=9), the mean age was reported as 39±6, and BCVA improved in 77% (7 cases), 11.1% (1 case), and 11.1% (1 case) of the cases within two, four, and ten weeks of treatment after the follow-ups, respectively. Indeed, the mean value of central macular thickness showed improvement from 4.72±1.40 to 3.93±9.8 microns (P=0.211). The SRF decreased during follow-up treatment with the mean time of 0.7±0.6 months; however, central macular thickness, choroidal thickness, and BCVA revealed no significant change. Topical dorzolamide might improve BCVA and decrease SRF in patients with CSC. This case series study demonstrated that topical dorzolamide might be effective in the treatment of CSC.

The incidence of thyroid and the prevalence of follicular carcinoma is rare in childhood and adolescents; however, it is considered as the second most common pediatric thyroid malignancy. Vascular invasion, distant metastasis, and tumor size greater than 4 cm are among the factors leading to total thyroidectomy followed by radioactive iodine therapy. The tumor size of the case in this study was 4.8 cm; as a result, total thyroidectomy was performed. The incidence of injury to the recurrent laryngeal in children is 0-40% due to its small size compared to that of adults. Furthermore, one of the prevalent complications of this operation is hypocalcaemia which is observed in 0-30% of the patients. None of these complications were present in the case. According to the author's experience, any swollen body in the neck should be considered important even if the incidence of a cancer is rare.

Brucellosis is one of the most important zoonosis. It causes significant economic and medical problems in countries throughout the world, including Iran. According to the available literature, brucellosis rarely causes intracranial space-occupying lesions. In this case study, we reported an intracranial mass in a 52-year-old male who were affected with brucellosis. The patient was referred to Vali-e-Asr hospital with right hemiparesis and transient speech impairment. The symptoms had begun sub-acutely and had gradually progressed. His past medical history was completely normal. Moreover, he had not consumed raw meat, had not been exposed to animal bite and slaughter within the recent weeks. In the initial assessment, the results of Wright agglutination and Coombs Wright tests level were 1/640 (a Wright’s titer of less than 1/80 is considered normal in Iran). The serum level of 2-Mercaptoethanol was 1/320 that was higher than the normal value. Brain-computer tomography (CT) scan and magnetic resonance imaging (MRI) were performed due to the inconsistency of neurologic findings with the usual presentations of brucellosis. MRI and CT scan findings showed a 35×35×34 mm heterogeneous mass lesion containing multiple vascular components located in the left paraventricular region along with mild peripheral edema and mass effect. Due to the size and the location of the lesion and the neurosurgery consultation, surgery was avoided and follow-up suggested. Treatment of brucellosis was initiated and completed according to the national protocol with rifampin and doxycycline. Follow up were performed in 6, 12, and 24 months after completion of the treatment. The growth of brain lesion was also controlled and the serologic test results of brucellosis were obtained normal.