نشریه جراحی ایران
سال نوزدهم شماره 1 (بهار 1390)

Introduction & The purpose of this study is to evaluate the role of progesterone receptors in the prognosis of breast cancer. Out of 2350 articles published during 1983-2009, we selected 102 articles of which 50 are mentioned in this article. Progesterone receptor has a significant role in the production and progress of breast cancer and along with estrogen has an important role in its prognosis and estimation of response to the treatment. Progesterone receptor have important role in the prognosis of breast cancer.

Introduction & For evaluation of laboratory data in the diagnosis of suspected acute appendicitis, many studies has been performed. In addition to White Blood Cell count (WBC) new laboratory variables such as C - reactive protein (CRP) and procalcitonin (PCT) have been introduced to help for a more definite evaluation. But, the findings are different and uncertain. The sensitivity and specificity of these variables are important for better diagnosis and in this study were assessed. A prospective cross-sectional study was done, which included 100 suspected patients with acute appendicitis who were admitted to a university hospital. After clinical evaluation and physical examination, WBC, CRP and PCT were determined. Decision for operation was made according to Alvarado scaling. After appendectomy and according to the pathologist report the patients were divided into two groups, having acute appendicitis or normal appendix. The sensitivity and specificity of these tests were compared between the two groups. In the 100 cases involved, 71 patients were male and 29 were female. The mean age of patients was 28.01±12.68 year. After operation, it was established in pathologic evaluation that 83 patients had acute appendicitis (AA), and 17 patients had normal appendix (NA). As far as WBC (P= 0.001) and Alvarado Scaling (P= 0.006) were showed. There was a significant difference between the two groups. But there was no significant for CRP (P= 0.025) and PCT (P= 0.042). Sensitivity of WBC, CRP and PCT were 85.5%, 92.77% and 55.42% respectively. Also, the specificity of WBC, CRP and PCT was 41.17%, 11.76% and 29.41% respectively. In the diagnosis of acute appendicitis use of symptoms and signs and laboratory data is helpful, although CRP and PCT can also help us in diagnosis in difficult situation.

Introduction & Breast cancer is one of the main causes of cancer-related mortality, resulting in approximately 40,000 to 50, 000 deaths annually. Breast cancer is the most prevalent cancer in Iran and in the world, but the epidemiological aspects of Iranian breast cancer is uncertain. Early diagnosis of cancer cells in the peripheral blood is a critical determinant for proper treatment. In spite of the heterogeneity of breast cancer at the molecular level, circulating tumor cells (CTCs) may provide a novel marker. On the other hand, approximately 20-40% of breast cancer patients have shown detectable Cytokeratin 19 (CK19). In the present study, the RNA of blood cells of 60 samples (30 patients and 30 normal) was extracted. The RT-PCR technique was applied to the extracted RNA, using specific primers. CK19 expression was evaluated by statistical chi-square test. Cytokeratin-19 was found to be present in the blood of all the patients. However, normal samples were divided in two groups: a) with cytokeratin expression b) without cytokeratin expression. Cytokeratin expression was related with history of cancer in their family. Investigation on the presence of Cytokeratin-19 biomarker in the early stages of disease could be a suitable prognostic factor in blood of the patients. Study on a larger number of patients with more biomarkers with the predictive and/or prognostic value should be considered in the future studies.

Introduction & The management of the donor site after harvesting a skin graft is an important issue. The ideal donor-site dressing would promote healing time, reduces pain, reduces the number of times needed to change dressing, prevents infection and is cost effective. In this study we compared the skin graft donor site wound epithelialization time, infection rate and patient cooperation during the change of dressing between two groups having amniotic membrane (AM) dressing and conventional topical antibiotic dressing. 42 patients with 20-40% second and third degree burns enrolled in this randomized clinical trial study in Motahari burn center. In each patient two similar anatomic areas were selected randomly as control and intervention donor sites. In all cases the size and thickness AM of the skin was similar in the two donor sites. The dressing of the intervention site was done by amniotic membrane and the control site with gas-impregnated antibiotic ointment. Variables were assessed by experienced burn surgeons and trained nurses. The mean age and mean burn percentage of the patients were respectively 31.17 ± 13.72 year and 31.19 ± 10.56 percent. Patients in AM dressing group had better cooperation. The mean (SD) score of patient cooperation was 1.6 ± 0.79 in AM dressing and 2.93 ± 0.71 in conventional dressing group and this differences was significant (P

Introduction & Burn Injuries and Complications are still considered major threats to societies health standards. They are categorized as the most important reasons for child mortality and debility in Iran and also other countries; imposing physical, spiritual, social and economical injuries on patients, families and society. In order to decrease burn rate, prevent it and develop efficient strategies; we study burn epidemiological characteristics in this research. This descriptive and cross sectional survey was performed over a one-year-period among burned children admitted to Mottahari Hospital of Tehran. The subjects were 100 patients who were younger than 15 years old. Information was collected through questioners and through interviews with the patients and their companions. Analysis was carried out, using SPSS statistical analysis software and descriptive statistics. The highest incidence of burn injury was in the 1 to 3 year old group (72%). Their mean age was 3.28±2.83 and male to female ratio was 1.9:1 was 1.9:1. The most common environment in which burn injury occurred was their homes (96%).Ninety-eight percent of the burned were house wives. The most common education level of the mothers (94%) and the fathers (92%) were less than high school diploma. Forty-two percent of the fathers were workers and the average family income in 81% of the cases was estimated to be less than 3/ 000/ 000 Iranian Rials. Fifty five percent were urban people and the most common cause of burn was boiling water (66%). The most frequent areas of barns were the head and the neck, the upper limb and the upper trunk (25%). The total body burn surface area (TBSA) was less than 21% and 44-65% in 58% and 10% of the cases respectively. According to the results of this study, it seems that education of parents and children are essential to prevent burn accidents and there fore to decrease burn injuries and physical, social and economical burn complications.

Introduction & An effective management of hospitals needs the situation analysis of hospitalization pattern. Analysis of this pattern coordinates hospital activities with to the population demands. In the current research, hospitalization pattern of Bandar-abbas’s training hospitals, based on the International Classification of diseases (ICD-10) are reviewed. In this descriptive-analytic research, all medical records of the hospitalized patients from 2002 to 2007, were reviewed. Data were collected using data form created by researchers, based on 21 chapters of ICD-10. Then they were entered in SPSS16 and were analyzed by Pearson Correlation and Chi-Square tests. Age groups 15-24 years, 25-34 years and infants were the highest age groups admitted during these six years. The rate of the prevalence of the disease and death were 42.8% and 62.7% for men and 51.8% and 37.3% for women respectively. The most frequent disease and death were related to pregnancy status (21.3%) and Circulatory Diseases (29.4%) respectively. The trend of disease during the six years was going upward and the trend of increasing mortality had oscillation with a peak in 1382 (18/9%). Results showed disease patterns were changed from communicable diseases to non- communicable diseases and injuries. So due to high pathogenicity and disability of injuries, the managment of them is essential the presentation of hospitalization pattern provides necessary evidences for health system managers in their planning and policy making. This makes cost- effective interventions simple.

Introduction & Hernia is a defect in aponeurotic muscular layers of abdominal wall that is large enough to let intra-abdominal structures pass through a sack of hernia, which is a diverticulum. Because of the high prevalence of inguinal hernia in our society and the transient disability and discomfort caused by it, we decided to investigate the causes of inguinal hernia in 10-70 years old adults in Bushehr’s Fateme Zahra hospital for detecting risk factors in order to improve society’s health level. In a descriptive cross-sectional study of 10 to 70 years old patients, diagnosed as inguinal hernia, between April 2004 to March 2009 who, had a herniorhaphy surgery in Fatemeh Zahra and Bentolhoda Hospitals of Bushehr University of medical sciences, after informing the patients, taking their history and performing and physical exams. The results were evaluated by SPSS 13, using descriptive data. 763 patients with the age range of 38±15.4 were investigated, which included 92% men and 8% women. 474 patients (62.1% of cases) had non-incarcerated inguinal hernia and (37.9% of cases) 280 patients had incarcerated inguinal hernia. According to probable baseline causes of inguinal hernia, causes like heavy physical activity, cigarette smoking and other tobacco products, chronic constipation, positive family history, history of previous operation on inguinal area, history of chronic cough, benign prostatic hyperplasia, chronic obstructive lung disease and collagen vascular diseases, had respectively the most prevalence rate and it was significantly and meaningfully higher than the case of non-incarcerated group. Due to the high prevalence of inguinal hernia and the risk of incarceration and also its negative effects on society’s economic system and also considering the fact that most of the probable causes of this disease are controllable, country’s major programming for educating people to modify life style, can lead to better quality of life and improvement of country’s economics.

Most ingested foreign bodies pass through the gastrointestinal tract without a problem. Occasionally complications like obstruction and hallow viscus perforation occurs. Duodenal perforation due to foreign body ingestion is not common and observation is enough for most cases, but if it is long with sharp margins, especial consideration for its early removal with endoscopic intervention is needed. This could be true for long foreign bodies with blunt ends. Otherwise severe complications may occur, like our case study. The patient is a 3.5 years old boy come to emergency ward with complaint about generalized abdominal pain for 3 days ago with nausea and vomiting and normal defecation. The patient underwent laparatomy because of generalized tenderness and intraperitoneal free air; and there was a duodenal perforation in duodenojejunal junction due to foreign body and it was repaired with omental patch. The aim of this report is to attract especial attention to log ingested foreign bodies even with blunt end.