فهرست مطالب مسعود ناظم

Clopidogrel is an adenosine-5' diphosphate (ADP) receptor antagonist that eventually inhibits platelet aggregation. It is used concomitantly with percutaneous coronary interventions and in patients with acute coronary diseases. This study was conducted to determine the effects of preoperative clopidogrel administration on perioperative blood loss and transfusion requirements in patients undergoing coronary artery bypass graft (CABG) surgery. For 100 patients who underwent nonurgent first-time coronary artery bypass grafting surgery participated in this study. clopidogrel was discontinued in 2, 3, 5-6 or 7-8 days before surgery. A cell salvage device was used during surgery and salvaged blood was recorded. After surgery, chest tube output and need for blood transfusion were measured and recorded. Patient's mean age was 61.7 ± 8.0 years (range: 50 to 77). There was a reverse relation between the time clopidogrel had been discontinued and blood loss and need for transfusion of packed cell and blood products during and after surgery (P < 0.05 for all). Preoperative clopidogrel administration increases perioperative blood loss and need for blood transfusion in patients undergoing coronary artery bypass grafting surgery.

Laryngoscopy and endotracheal intubation are critical procedures and if the anthropometric indices of the patient leading to difficult intubation are not considered before the procedure، it can be accompanied by serious complications. One of the most practical concepts suggested about difficult intubation، is Cormack and Lehane criteria used in most medical centers. However، there is not any valuable study demonstrate the effect of anthropometric indices in difficult intubation and the immediate prediction of its complications. This study aimed to evaluate the correlation of anthropometric indices and hemodynamic changes after laryngoscopy and endotracheal intubation. This descriptive-analytic study was carried out in 2012 in Kashani hospital، Isfahan، Iran. 130 patients with fulfilling inclusion criteria were entered the study. The recorded data included age، weight، height، neck circumference، waist-to-hip ratio and body mass index. The difficulty of intubation was assessed when the patient was completely unconscious. The predictive role of obesity indices in difficult intubation and the cardiovascular changes after intubation was assessed using receiver operating characteristic (ROC) curve. The best cut-off point for body mass index (BMI) was 26. 56; according to this cut-off point، the sensitivity، specificity، and positive and negative predictive values (PPV and NPV) of BMI were 100، 38. 84، 10. 8 and 91. 1 percent، respectively. The best cut-off point for neck circumference was 38; according to this cut-off point، the sensitivity، specificity، PPV and NPV of neck circumference were 7. 85، 2. 28، 2. 45، 1. 91 percent، respectively. BMI، neck circumference and waist-to-hip ratio are valuable in assessing difficult intubation and their value is mostly due to NPV. Therefore، we can achieve a significant NPV and sensitivity in assessment of difficult intubation by considering all these indices.

Electroconvulsive therapy (ECT) is a medical treatment used in serious mental illnesses، in which a small amount of electricity passed the brain. The hemodynamic side effects include an initial parasympathetic response causing transient bradycardia، followed by a sympathetic discharge resulting in tachycardia، hypertension and a risk of arrhythmias. The aim of this study was to determine the effect of different doses of magnesium sulfate on cardiovascular response after electroconvulsive therapy. This clinical-trial، double-blind، randomized study was held cross over on 35 patients in electroconvulsive therapy (ECT) center of Noor hospital in Isfahan، Iran، in 2011. Each patient was randomly assigned to be allocated twice into each of the four test groups which received placebo (control) or 10 (second)، 20 (third)، or 30 (forth) mg/kg of MgSo4. Systolic and diastolic arterial blood pressures، heart rate and oxygen saturation values were recorded on arrival for the ECT and then at 0، 1، 3 and 10 minutes after the end of the ECT-induced seizure. Mean systolic blood pressure at 0، 1 and 3 minutes after the end of the ECT-induced seizure of the second (126. 140 ± 20. 937، 122. 710، ± 18. 524، and 115. 710 ± 17. 504 mmHg، respectively) and third (123. 000 ± 18. 077، 123. 710 ± 14. 770، and 116. 290 ± 14. 201 mmHg، respectively) groups were statistically different compared to controls. Besides، mean diastolic blood pressure at 0، 1 and 3 minutes after the end of the ECT-induced seizure of the second group (76. 000 ± 10. 304، 74. 430 ± 9. 669، and 76. 140 ± 9. 082 mmHg، respectively) were statistically different compared to control group. Mean arterial blood pressure (MAP) at 0، 1 and 3 minutes after the end of the ECT of the second (92. 140 ± 12. 237، 90. 710 ± 12. 328، and 89. 330 ± 12. 425 mmHg، respectively) and third (91. 670 ± 11. 602، 90. 860 ± 10. 905، 89. 520 ± 9. 873 mmHg، respectively) groups compared with the control group were statistically different، too. Heart rate and arterial oxygen saturation at different times in the four groups were not statistically different. Based on the results of this study، magnesium sulfate with doses of 20 and 30 mg/kg attenuated the systolic and diastolic blood pressure and mean arterial blood pressure (MAP) response of electroconvulsive therapy without reducing the duration of seizure activity.

There are many controversies about relationship between hernias and connective tissue disorders in children. The aim of this study was to determine the relationship of benign joint hypermobility syndrome (BHJS) with inguinal hernias in children. This descriptive analytical study involved children of 2-12 years old who were diagnosed with inguinal hernia during 2009-11. Subjects were admitted to pediatric or pediatric surgery wards of hospital affiliated with Isfahan University of Medical Sciences (Iran). Overall، 200 children in two groups of patients with inguinal hernias and controls were included. Beighton score was used for diagnosis of BHJS in the admitted children and the control group. For evaluation of collected data and the relationship of diseases، we used SPSS18 and chi-square test. The mean Beighton score was 6. 2 ± 2. 0 in the case and 2. 7 ± 2. 2 in the control group، i. e. children with inguinal hernias had significantly higher Beighton scores (P < 0. 001). Based on this study، BHJS is prevalent in children with inguinal hernias. Therefore، in every patient with inguinal hernias، the presence of concomitant BHJS should also be considered.

Intussusception is the telescoping of one portion of the intestine in to another. The appropriate treatment can reduce the complication, mortality and morbities. The first line of non surgical treatment is contrast enema. This study was done to identification the clinical and laboratory predictors of successof barium enema. This was a cross-sectional study that considered all the children with intussusceptions, who were refered in 2009 and 2010 to Alzahra hospital, Iran. All of the needed information including age, sex, fever, leukocytosis, free fluid in sonography, time of symptom appearance and positive bloody stool was recorded in a questionnaire. Then we committed Barium enema for all of them, and evaluate the relationship between the success of barium enema with gathered data by chi square and Student t-test. In this study we evaluated 45 children with intussusceptions. In 18 subjects the barium enema treatment was success. The results of this study showed a significant correlation between positive blood stool and free fluid in sonography with unsuccessful of barium enema treatment. According to our results in children with bloody stool or free fluid in sonography we recommend only one time barium enema. If the treatment is unsuccessful, it is better to advise patients for open surgery.

The carcinogenic effect of radiation is directly related to the exposure rate and the risk is even more in infants. The scope of the present study is to evaluate of the average of cumulative radiation dose in neonates in the neonatal surgery ward due to diagnostic and therapeutic radiologic procedures during the admission period, in Alzahra hospital of Isfahan, Iran. This investigation was a descriptive study on 168 neonates. It was done in neonatal surgery ward during last 9 months of 2009 in Alzahra hospital of Isfahan, Iran. The patients were selected randomly and with no attention to age, sex, diagnose and admision time. Thermo luminescent dosimeters (TLD GR200), were used for dosimetry and each chips was putted in a plastic envelope on the neonate sternum during the admission period. The cumulative absorbed dose by each patient was stored during the admission by TLD and followed by reading by TLD reader. For using of TLDs, they were calibrated and two calibration factors (individual and batch) were performed in radiotherapy section of Seyed Al-shohada hospital of Isfahan, Iran. After checking the accuracy of calibration, the absorbed dose by each patient was achieved by using of calibration factors. The average of admission time for each patient was 7.64 days and the average of cumulative absorbed dose was 3.13 Millisievert (mSv) during this time. The maximum absorbed dose in one patient was 42.83 mSv. The average number of conventional radiography for each patient was 2.77. The average of conventional radiography and cumulative absorbed dose in patient with no examination or just simple x-ray examinations was 2.58 and 0.863 mSv, respectively. Chest x-ray examination was the most examination used here (338 person). The average dose for each chest x-ray examination was 0.313 mSv. The average of cumulative absorbed dose among patients with fluoroscopic examination was about 12.6 mSv. The cumulative absorbed dose in 19 patients was more than 10 mSv. The average of cumulative absorbed dose was not more than the dose limit according to reference levels, but in comparison with other medical centers in the world is very high. Therefore, it is necessary to pay more attention to reduce radiological imaging procedures, particularly about fluoroscopic procedures.

Imperforated anus is a congenital disease in which infant cannot deficate. About 25% of infants with imperforated anus have some other congenital diseases. This study aimed to investigate the attendant diseases and also the surgery complications in patients with imperforated anus underwent surgery treatment. This cross-sectional study was performed in Alzahra Hospital in Isfahan. 128 patients with imperforated anus underwent surgery during a decade were studied. Patients’ data were extracted from their files. To analyse data, descriptive tests were investigated. 25 patients had died after surgery. From the remaining 103 patients, 63 patients had no complications. The most common early complication was wound dehiscence and the most common late complication was stenosis. Incidence of associated anomalies was 40 percent and the most common associated abnormality was renal anomalies were seen in 16.4 percent of patients. Given the high prevalence of associated anomalies, and examinations of children for proper diagnosis of imperforated anus and treatment of associated anomalies is essential. In addition, carefully selection of and perform the correct surgical technique can reduce surgical complications. Parental education about the complications and follow-up in the recommended deadline is recommended.

Foregut duplication is commonly found in the posterior mediastinum. About 10-20% of these anomalies are associated with esophageal duplication. It can occur in all parts of esophagus. Although the duplication of cervical esophagus has been previously reported, a majority of it was found in the thoracic oesophagus. Infant esophageal duplication is usually associated to respiratory distress or asymptomatic thoracic mass, casually detected in x-ray. Case Report: In this report the case was a 7 months old infant (7.5 kg) with the chief compliant of respiratory distress, fever and nutritional intolerance. Physical examination of the case showed dehydration, stridor, tachypnea, intercostal retraction and neck stiffness. Plain chest radiogram showed a dual cystic mass in the distal neck region. Neck and chest CT- scan showed cervical cystic lesion disseminated to the posterior mediastinum, probably propagated to the respiratory system. For treatment, cystic lesion attached to the esophagus was partially resected, esophagus was repaired and the remaining mucosa of the cyst was removed, then gastrostomy tube was inserted. Although the cervical esophageal duplication of cysts are rare in infant respiratory distress, they must be considered as one of differential diagnoses of the cervical masses.

Using one subcutaneous infiltration of Bopivacaine can cause a good pain relief in pediatric surgery, so the child may no longer need rectal Acetaminophen after surgery. In this study, we compared the efficacy of the two drugs. This was a clinical trial, performed on 141 pediatric patients between 6 months to 3 years old with unilateral or bilateral inguinal hernia or undescending testis. Patients were divided randomly into two groups. The first group received infiltration of Bopivacaine preoperatively and the second received the routine rectal Acetaminophen after surgery. In both groups pain score was measured with FPRS score 3,6,12 and 24 hours after surgery. After collecting data they were analyzed with T-student and Friedman tests. P<0/05 was considered significant. Global FPRS pain score was lower in the group treated with Bupivacaine infiltration on 3 and 6 hours after surgery (p<0/05), but in 12 and 24 hours after surgery no significant difference was seen in the two groups. This study showed that, infiltration of Bupivacaine reduces pain better than Acetaminophen, especially during the first 6 hours after surgery. So because of better pain control and also single administration, we suggest using infiltralition of Bupivacaine preoperatively.

Cystic hygroma is a disorder in lymphatic vessel formation that involves the adjacent organs and can affect them due to its fast growing nature. The main treatment for cystic hygroma is surgical intervention that can have many complications after surgery. Treatments other than surgical interventions is the use of sclerosing agents. The goal of this study is to analyze the effect of Beliomycin in treating cystic hygroma. This quasi experimental study was carried out clinically at st-al Zahra and Kashanie hospitals of Isfahan from 1372 to 1383. A checklist including age, sex, cyst location, cystic hygroma volume before and after Beliomycin injection and/or surgery, was completed for each patient. Data was analyzed by T and paired T-Tests. p<0.05 was considered meaningful. The study was carried out on 72 patients. 24 patients were treated with Beliomycin and 48 patient by surgery. Patients age was below 1 month up to 18 years old. Cystic hygroma was mainly located at neck region(46.8%). The average size of cystic hygroma was 103.9±29.66cm3 before Beliomycin injection and 34.91 16.19cm3 after that (p=0.004). and 43.511±7.81cm3 before surgery and 1.39±1.39 cm3 after that(p=0.006). The rate of recurrence of lymphingoma in the surgery treated group was 25.1% and in the group treated with Beliomycin was 29.2% with no significant difference. Regarding the considerable decrease in cyst volume after Beliomycin injection and it,s low complication compared to surgery, this method can be used as a primary treatment or supplementary to surgery.