فهرست مطالب zeinab tamannaie

 To evaluate the association between menstrual cycle disorders with obesity in Iranian women.

In the present case-control study, 405 obese women of reproductive age who referred to the Obesity Clinic of Minimally Invasive Surgery Research Center, Rasoul-e-Akram Hospital, Tehran, between Jan 2013 and Oct 2015 were included as the case group and were compared with a control normal-weight group, selected from their family members (N=293). Menstrual cycle characteristics were documented in a researcher-designed checklist. For the statistical analysis, we used SPSS version 19 and Stata version 5.0.

In the case group, 47 women (11.6%) had irregular menstrual cycles, while it existed in 22 (7.5%) of the control group (P<0.001). The prevalence of different menstrual disorders was as follows: polymenorrhea 107 (26.4%) in cases and 51 (17.4%) in controls (P<0.001), oligomenorrhea 22 (5.4%) in cases and 16 (5.5%) in controls (P<0.001).

The results of the present study showed that morbid obesity increases the risk of menstrual irregularities and dysmenorrhea; therefore, it is essential to pay greater attention to this issue in morbid obese patients for proper management of this disturbing comorbidity.

Nowadays quality of life (QOL) is an important part of health and measuring health-related QOL after surgery is necessary for decision-making by patients and surgeons. To assess post cholecystectomy QOL, documentation of high quality care has been subjected to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years.
The aim of this study was to compare quality of life after surgery in candidates of laparoscopic and open cholecystectomy.
Patients and This study was an optional part of a longitudinal study for comparison of quality of life in candidates of laparoscopic (LC) and open cholecystectomy (OC). One hundred consecutive cases of hospitalized patients, aged 20 to 65 years, at two hospitals of Karaj, Iran (Imam Khomeini and Alborz), were recruited in the study from May to December 2011. Patients were divided to two groups based on the order of admission and the surgeons’ and patients’ preference. Patients were evaluated with the medical outcomes study 36-item short-form health survey (SF-36). Quality of life was measured at three points of time (the baseline was two and four weeks after surgery) using this health questionnaire. Differences between baseline time periods of two and four weeks were compared by independent-samples t-test and within groups the time periods were compared by the paired-sample t-test.
Two weeks after the operation, in the LC group, the QOL scores decreased significantly in physical functioning, physical status, body pain and emotional status (for all of them P ≤ 0.01), whereas, in the OC group all the aspect of QOL decreased (for all of them P Quality of life is an important factor affecting medical and surgical treatment, as well as decision-making. Improvement of short-term quality of life after laparoscopic cholecystectomy in comparison to open cholecystectomy proves the obvious superiority of LC over OC.

the general population, even physically active people including football referees can be in danger of developing cardiovascular diseases and having related risk factors. The aim of this study was to evaluate the cardiovascular disease (CVD) risk factors among Iranian football premier and the first league referees during 2014-2015.
Material and All the Iranian football premier and first league referees participated in this cross sectional study. Subjects’ data were collected using the standard pre competition medical assessment form as well as the laboratory tests. Data analysis was done by the SPSS software (version22.0).
Among football referees, 23.5 % had at least two CVD risk factors therefore they were stratified as having a moderate risk for developing CVD disease. Some CVD risk factors including smoking and obesity had low prevalence among the subjects. We found that 18.4 % of the subjects were overweight and 45.9 % suffered from dyslipidemia (26.5 % low HDL, 20.4 % Total cholesterol abnormality, 14.3 % high LDL). We also found that 17.3 % of our subjects had glucose intolerance. Positive family history of CVD was seen in 14.3% of subjects. Hypertension had 4.1% prevalence among subjects.
This study found that despite being physically active, 23.5 % of football referees had at least 2 CVD risk factors and therefore stratified as having moderate risk factors to develop CVD.

Type 1 diabetes mellitus (T1DM) is one of the most common chronic pediatric conditions, with potentially life-threatening sequels. However, good metabolic control can protect the patients against sequels. The aim of this study was to examine the relationship between awareness of the mothers about this disease on improving diabetic children metabolic control and also, to examine the relationship between socioeconomic situations of families and control of diabetes in this group of patients.Patients and This is a cross-sectional descriptive analytic study on 80 diabetic children and their mothers, who were registered in the diabetes association of Iran, for outpatient control of disease. Diabetes knowledge was measured by Michigan diabetes knowledge test and glycemic control was assessed by glycosylated hemoglobin (HbA1c). To assess the socio-economic status of a diabetic child’s family, educational level, occupational and marital status of parents were asked and the socioeconomic status (SES) was evaluated with Hollingshed four-factor index of SES. Mothers’ mean knowledge score was 17.72, children’s mean HbA1c was 7.77 and mean of SES was 27.89. There was no significant correlation between children’s HbA1c and mother’s SES. Also, there was an inverse linear relationship between mothers’ knowledge score and children’s HbA1c and there was a direct linear relationship between the mothers’ knowledge score and SES. Finally, based on the results obtained in this study, it can be concluded that the awareness of mothers of T1DM children has a good impact on blood sugar control, whereas the SES of families has no direct effect on blood sugar control. Additionally, SES can indirectly impact on the consciousness of mothers and lead to the reduction of HbA1c.

Monopolar surgery is applied mostly in major operations, while bipolar is used in delicate ones. Attention must be paid in electrosurgery application to avoid electrical burns.

We aimed to assess factors associated with electrosurgery burns in cardiac surgery operating rooms.

This was a case-control study in which two groups of 150 patients undergoing cardiac surgery in Imam Khomeini Hospital were recruited. Several factors like gender, age, operation duration, smoking, diseases, infection, atopia, , immunosuppressive drugs use, hepatic cirrhosis, and pulmonary diseases were compared between the two groups. Patients were observed for 24 hours for development of any burn related to the operation. Data was analyzed using SPSS v.11.5, by Chi square and T-test.

Patients in the two groups were similar except for two factors. DM and pulmonary diseases which showed significant differences (P = 0.005 and P = 0.002 respectively). Seventy-five patients from controls and 35 from the study group developed burns, which was significant (P ˂ 0.0001).

None of the factors were significantly related to developing burns. The differences between the two groups highlights the importance of systems modifications to lessen the incidence of burns.

Since 1996 with improvement of endoscopic instrumentation several novel minimally invasive techniques have been developed to perform thyroid operations. The advantages of endoscopic procedure includes better magnification of anatomy, improved illumination of the operation field, earlier recovery, better pain control, and better cosmetic results. Yet it’s performed rarely and only by few surgeons around the world, as it has some limitations like the size of the nodule.. We herein present a patient with right-sided thyroid cold nodule and follicular presentation on fine needle aspiration (FNA), which successfully underwent endoscopic thyroidectomy through an axillary incision in Hazrat Rasul Akram hospital and tolerated the procedure well without any complications and was discharged with a very good condition.. If the indications and contraindications of minimally invasive thyroidectomy are taken into account, it seems to be a safe procedure and regarding the benefits of this procedure, it''s recommended that surgeons pay more attention to this newly developed technique..

Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant. We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran. In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion.

Tuberculosis (TB) is a disease with diverse clinical manifestations. It typically attacks the lungs (pulmonary); however, it may also affect other parts of the body (extrapulmonary) with or most commonly without lung involvement. Notable extrapulmonary infection sites include pleura, central nervous system, lymphatic system, genitourinary system, bones and joints, and abdomen. Abdominal TB is one of the most prevalent forms of extrapulmonary presentations of this variable disease. Given the patients with abdominal complaints especially in developing countries, where the disease is endemic, it should be kept in mind that abdominal TB has numerous differential diagnoses.. Our case is a 46 year-old female with left upper abdominal pain and mass sensation, with no associated signs or symptoms, but negative family history of TB and carcinoma. The patient underwent several diagnostic procedures so that the ultimate cause for her abdominal pain would be discovered among various existing differential diagnoses.. Peritoneal TB, although not very common, is still the important cause of not only abdominal symptoms but also female infertility. The need to pay more accurate attention to peritoneal TB in endemic areas, especially in young patients considered to have peritoneal carcinomatosis, seems very important..

Delay in diagnosis and treatment of acute appendicitis (AA) results in an increased rate of perforation, postoperative morbidity, mortality and hospital length of stay. Several biochemical parameters including white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL6) and Procalcitonin (PCT) have been used to further improve the clinical diagnosis of AA. The aim of this study was to assess the value of procalcitonin as a predictor of diagnosis and severity of appendicitis in order to improve the clinical decision making, since other studies have been unable to demonstrate a diagnostic value for PCT elevation in acute appendicitis. One-hundred patients who underwent open appendectomy, including 75 men and 25 women with a mean age of 28 years were included in this study. Procalcitonin values were measured by an immunofluorescent method). Serum PCT>0.5 ng/ml was considered positive. The PCT serum values were measured in four different categories, including ˂0.5ng/ml, 0.5-2 ng/ml, 2-10ng/ml and more than 10ng/ml. The sensitivity and specificity of PCT level measurement for acute appendicitis diagnosis were 44% and 100% respectively. The value of PCT increased with the severity of appendicitis and also with the presence of peritonitis and infection, at the site of surgery. Procalcitonin measurement cannot be used as a diagnostic test for adult patients with acute appendicitis and its routine use in such patients is not cost effective and conclusive. Procalcitonin values can be used as a prognostic marker and predictor of infectious complications following surgery and it can help to carry out timely surgical intervention which is highly recommended in patients with PCT values more than 0.5ng/ml.

Distal pancreatectomy has been a standard technique for pancreatic body and tail lesions for years ago. Recently, it is being performed laparoscopically in a perfect manner. There are two common methods for this procedure. One is distal pancreatectomy with splenectomy and the other is distal pancreatectomy with spleen preservation. In patients with splenic vessels involvement, it is not recommended to save the spleen, because of existing chance of splenic ischemia. On the other hand, after splenectomy there is great chance of immune system problems and fatal infections. This report, presents a patient who underwent laparoscopic distal pancreatectomy due to cystic tumor of pancreatic body with splenic vessels involvement and ligation of them was necessary and the spleen was saved successfully with no following complications..

Post laparoscopic cholecystectomy pain management can reduce recovery and discharge time. Non-steroidal anti-inflammatory drugs and opioids are used for this purpose.. This randomized clinical trial evaluates the efficacy of diclofenac rectal suppository for the management of postoperative pain..Patients and Forty four patients were randomized to receive either 100 mg diclofenac rectal suppository or placebo at the time of recovery and three hours later after laparoscopic cholecystectomy. Postoperative visual analogue pain scale (VAS, ranges 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS score was ≥ 7, 25mg, pethedin was given intravenously as a rescue analgesic.. In both groups, VAS score was reduced in 24 hours. It was statistically lower in diclofenac group rather than placebo group in all intervals except at the time of recovery. Moreover, the mean pethedin consumption dose and the incidence of administration of postoperative rescue analgesic were statistically lower in diclofenac group. Postoperative bleeding was not statistically different between two groups.. Diclofenac rectal suppository provided simple and safe pain relief in laparoscopic cholecystectomy..

Delay in diagnosis and treatment of perforated appendicitis may cause life-threatening complications. The aim of this study was to determine and compare pre-operative total and direct bilirubin levels in cases of simple and perforated acute appendicitis in order to improve the clinical decision making. This prospective observational study included eighty patients who underwent open appendectomy, during a one-year period from March 2010 to March 2011 in the surgical department of Hazrat-e-Rasool Akram Hospital, an academic teaching hospital in Tehran- Iran. Pre-operative total and direct levels of bilirubin were compared in two groups of histologically proved appendicitis (simple and perforated), each including 40 patients. Eighty patients who underwent open appendectomy including 70% men and 30% women with a mean age of 34±11 years in Group I (perforated appendicitis) and 47.5% women and 52.5% men with a mean age of 33±14 in Group II (simple appendicitis) were included in this study. The mean bilirubin levels were higher for patients with perforated acute appendicitis compared to those with a non-perforated simple appendicitis (1.04±05 mg/dl vs 0.7±0.1 mg/dl) and this difference is highly significant (p<0.01). Assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute simple appendicitis and total bilirubin should be used as an independent parameter in the early diagnosis of appendix perforation.

Post laparoscopic cholecystectomy pain management can reduce recovery and discharge time. Non-steroidal anti-inflammatory drugs and opioids are used for this purpose.. This randomized clinical trial evaluates the efficacy of diclofenac rectal suppository for the management of postoperative pain..Patients and Forty four patients were randomized to receive either 100 mg diclofenac rectal suppository or placebo at the time of recovery and three hours later after laparoscopic cholecystectomy. Postoperative visual analogue pain scale (VAS, ranges 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS score was ≥ 7, 25mg, pethedin was given intravenously as a rescue analgesic.. In both groups, VAS score was reduced in 24 hours. It was statistically lower in diclofenac group rather than placebo group in all intervals except at the time of recovery. Moreover, the mean pethedin consumption dose and the incidence of administration of postoperative rescue analgesic were statistically lower in diclofenac group. Postoperative bleeding was not statistically different between two groups.. Diclofenac rectal suppository provided simple and safe pain relief in laparoscopic cholecystectomy..

Distal pancreatectomy has been a standard technique for pancreatic body and tail lesions for years ago. Recently, it is being performed laparoscopically in a perfect manner. There are two common methods for this procedure. One is distal pancreatectomy with splenectomy and the other is distal pancreatectomy with spleen preservation. In patients with splenic vessels involvement, it is not recommended to save the spleen, because of existing chance of splenic ischemia. On the other hand, after splenectomy there is great chance of immune system problems and fatal infections. This report, presents a patient who underwent laparoscopic distal pancreatectomy due to cystic tumor of pancreatic body with splenic vessels involvement and ligation of them was necessary and the spleen was saved successfully with no following complications..

There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT) in laparoscopic cholecystectomy. The aim of this study was the assessment of patients’ condition after laparoscopic cholecystectomy without any prophylactic measure. 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Only one case of partially thrombosis (1%) was found by duplex scanning which was managed conservatively. Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.

Meralgia paresthetica (MP) is a benign clinical syndrome of entrapment of the lateral cutaneous nerve in the thigh. Among the complications of bariatric surgery, neurologic complications are not uncommon and of these complications, MP is a frequent clinical diagnosis. Thus, knowing the clinical risk factors of MP is of great importance as they help with the differential diagnoses of MP from other serious disorders.. To study the prevalence of MP and its clinical risk factors after bariatric surgery in a sample of Iranian morbid obese patients undergoing surgery for obesity.. Patients and In a cross-sectional study, 163 patients (146 females and 17 males), who underwent bariatric surgery, were called one to 48 months after their surgery. After obtaining their consent, the patients were interviewed and completed a questionnaire containing history and presentation of neuropathy for this study. In addition, some of the variables of the questionnaire were filled using the patient’s medical records.. One month after surgery, 32 patients (19.5%) had neurologic signs or symptoms of MP located in their lateral thigh. Diagnosis of MP was made in 21 (17 women and four men) patients (12.8% of all patients), sub-acute polyneuropathy in seven patients (4.3%), and acute polyneuropathy in the remaining four patients (2.4%). No specific treatment was given to the patients with MP. Symptoms of MP were resolved within six months in 15 patients (71.4%). In a univariate analysis of MP, only a history of a neuropathy was significantly correlated with the occurrance of MP after surgery (P = 0.004) with an odds ratio of 4.2 (95% confidence interval: 1.4-12.2).. MP is not a common complication after bariatric laparoscopic surgery, however, a history of neuropathy and diabetes should be mentioned to surgeons as risk factors for MP. Additionally, using a belt for fixation could be a an etiologic factor for MP after bariatric surgery.

Small bowel obstruction is one of the most common surgical emergencies and main causes of hospital admissions. Diatrizoate Meglumine Gastrografin, a hyperosmolar water-soluble contrast agent, has been used to triage patients with small bowel obstruction for an operative or a non-operative management. It can also have a therapeutic effect by increasing the pressure gradient across obstructive sites that may result in resolving the obstruction.. The aim of this study was to test the gastrografin effect in the resolution of small bowel obstruction..Patients and In this cross sectional–descriptive study, gastrografin was given to patients diagnosed with small bowel obstruction in clinical and radiological grounds. The contrast passage was assessed by serial X-rays. If the contrast remained in the small bowel, a decision was made as to whether proceed to surgical intervention, based on clinical condition. The patients were divided into two groups: A, who finally required surgery, and B, who were resolved by gastrografin administration.. Forty six patients were entered into the study. Thirty seven of the patients (80%) received a non-operative course in whom the contrast was observed in the large bowel. They had a mean hospital stay of 4.6 days. Nine patients (20%) required operative intervention. These patients had a mean hospital stay of 8 days.. This study has demonstrated that gastrografin was highly effective in the management of adhesive small bowel obstruction resulting in a decreased need for surgery and hospital stay.

The invention of central venous catheters (CVC) for hemodialysis (HD), brought about a fundamental change in the treatment of patients who needed HD, from the late 1970’s till the present time. Nowadays the use of CVC is a common medical procedure. Increasing use of these methods necessitates clarification of the exact nature of the effects, and potential complications for surgeons.. This study attempts to determine the frequency of CVC; complications, survival rates and outcomes in HD patients, treated at the Hasheminejad Kidney Center, Tehran from January 2010 till June 2011..Patients and In this cross-sectional descriptive study, we collected data (using the census method) from the records of all patients over the age of 18 years, who had been referred, from January 2010 till June 2011, for CVC insertion. Catheter sites, related complications, creatinine (Cr), hemoglobin (Hgb), survival rate of catheters and the patients’ demographic data, were collected and analyzed.. In this study, 150 patients were evaluated, 122 participants (81%) were male and 28 (19%) were female. The patients’ average age was 56.2 ± 5 years (19 to 87 years). Regression analysis between the patients, with and without complications, showed that increasing age (P = 0.003, RR = 0.78), decreases in Hgb (P = 0.04, RR = 0.34) and also increased Cr (P = 0.023, RR = 0.45), and BUN (P = 0.014, RR = 0.37) are significantly correlated with catheter-related complications as independent risk factors. The one month survival rate of temporary catheters was 77.3% and their two-month survival was 60%. The overall rate of complications in the present study was no higher than in other similar studies. Anemia rates, however, were much higher in our patients. Most of the complications involved catheter infections, followed by catheter thrombosis. CVC survival rates in Iran have an acceptable outcome and results of this study were similar to those of past studies.