Journal of Surgery and Trauma
Volume:7 Issue: 3, Autumn 2019

Cholecystitis is one of the most common diagnoses among patients referred to surgical emergencies with acute or recurrent abdominal pain. The mainstay of treatment for this disease is cholecystectomy, and the gold standard procedure is laparoscopic cholecystectomy. Pain which is the most common complication after laparoscopic cholecystectomy gives priority to the administration of the best pain relief medicine. This study aimed to compare the efficacy of diclofenac suppository with intravenous Meperidine for pain relief in opioid-dependent and independent patients undergoing laparoscopic cholecystectomy.

A total of 120 opioid-dependent and independent patients (60 each) participated in this single-blinded study. Each group was randomly divided into two equal subgroups and 100 mg diclofenac suppository and 25 mg Meperidine via intravenous injection were administered to the participants in each group. Pain intensity was measured by the Verbal Rating Scale (VRS) pain scale 24 hours after recovery. The data were analyzed in SPSS software (version16.0). A P-value of less than 0.05 was considered statistically significant.

Based on the results of the study, Meperidine for pain relief after laparoscopic cholecystectomy was reported to be more effective in opioid-dependent patients and diclofenac in opioid-independent patients. Moreover, the use of diclofenac in 90% of opioid-independent patients resulted in favorable responses and ease of pain (Fisher=61.01; P=0.001), and the rate of opioid-dependent patients treated with Meperidine with excellent responses was measured at 83.3% (Fisher=56.98, P=0.001).

Meperidine can be the mainstay of treatment for pain relief after laparoscopic cholecystectomy used in opioid-dependent patients; however, the selected drug for pain relief after laparoscopic cholecystectomy in opioid-independent patients is diclofenac.

Outcomes of patients undergoing damage control laparotomy (DCL) for abdominal gunshot wounds (GSWs) remains relatively unknown. The purpose of this study was to evaluate the impact of DCL on long term morbidity and survival.

This retrospective study was conducted on patients undergoing a damage control laparotomy for abdominal GSWs. The data were collected using 50 consecutive trauma patients over a 4.5-year-period between August 1st, 2004 and September 30th, 2009. The patients were classified regarding the characteristics, such as age, perioperative physiological parameters, trauma indices, number of abdominal GSWs, critical care unit stay, hospital length of stay, morbidity, and mortality. Univariate and multivariate logistic regression was employed to compute the odds of survival and estimate the unadjusted and adjusted association between these factors.

According to the results, the majority of the patients were male (96%) with a mean age of 29.7 years who had a single abdominal gunshot wound (60%). Liver injuries (58%) followed by small bowel (44%), majors venous (40%), and colonic (38%) trauma were observed in the patients. The overall mortality rate was obtained at 54%. The mean length of intensive care unit stay and mean hospital length of stay were 7 and 13 days, respectively. Factors associated with a decreased odds of survival included Penetrating Abdominal Trauma Index (PATI) > 25, intra-operative blood lactate level > 8 mmol/L, and massive transfusion >10 units packed red blood cells.

After controlling the confounding factors, a PATI score of > 25 was associated with a decreased odds of survival (OR: 0.20, P=0.04).

Ultrasound biometric measurements have long been the gold standard in cataract surgery. In the course of time, optical biometry replaced ultrasonography as the standard technique for axial length measurements of the eyes. However, optical biometry is not accessible in some centers; therefore, the present study was carried out to evaluate the predictability of refractive outcomes following phacoemulsification using applanation ultrasound biometry.

In this prospective study, ocular biometry was performed using an applanation ultrasound. Thereafter, mean absolute error (MAE) and the percentage of eyes achieving postoperative refraction within 0.5, 1.0, 1.5, and 2.0 D of the predicted spherical equivalent were calculated for SRK/T IOL formulas through a temporal clear corneal incision 1 month after phacoemulsification.

A number of 299 adult cataract patients (323 eyes in total) were enrolled. Absolute refractive mean error was obtained as 0.51±29 D 1 month after the surgery. In addition, 59.4% of the eyes achieved postoperative refraction of ±.5 D of the predicted value. Furthermore, 95.7 % of the eyes were found to be within ± 1.00 D.

Based on the results of the present study, refractive outcomes after phacoemulsification using applanation ultrasound biometry are comparable with international standards for good practice and outcomes. It is worthy to note that this method offers considerable advantages, such as a few measurement limitations, cost-effectiveness, and accessibility.

Appendectomy is one of the most performed surgeries worldwide. There are lots of factors involved in the incidence of appendicitis, and most of them vary among populations. Therefore, the present study aimed to evaluate the epidemiological aspects of appendicitis in Birjand, Iran, for the first time.

This prospective study included 666 cases out of 673 acute appendicitis patients treated surgically in Imam Reza Hospital in Birjand, Iran, from May 2017 to 2019. The data were analyzed regarding gender, age groups, and season in SPSS software (version. 22) using a t-test and the Chi-square test. A p-value of less than 0.05 was considered statistically significant.

The annual incidence of acute appendicitis in Birjand was 12.74 per 10.000 population with the mean age of 25.43±14.97 years. The highest frequency of appendectomy was observed in 11-20-year-old groups (32.1%) and then in 21-30-year-old groups (27.3%). The frequency of the appendectomy was higher in males than females (P=0.005), and the peak of the surgeries was in the summer. Moreover, the majority of the admitted patients in the summer were male (n=123), whereas the frequency of female patients in the autumn was higher than that of males (n=81). The most frequent pathological diagnosis in both genders was acute gangrenous appendicitis (i.e., 44% in females and 40% in the male). Furthermore, the incidence rates of advanced stages of appendicitis, such as "acute supportive appendicitis and periappendicitis" and "acute supportive appendicitis and priappendicitis with perforation" were significantly higher in male than female (P<0.05).

The findings of this study provide basic epidemiological information for the first time regarding appendicitis status in Birjand, Iran. Since the appendicitis was more frequent among youth and was more complicated in males, it is essential to inform these target groups about the signs and symptoms of this medical emergency.

Microbial contamination of hospital gowns is the main reason for the dissemination of nosocomial infections. Bacteria are the cause of most of these contaminations. The present study aimed at determining the frequencies and types of bacterial pathogens on the surface of personnel gowns, before and after washing with sodium hypochlorite 5% in Vali-e-Asr Hospital, Birjand, Iran.

In the current study, the sampling was carried out in two steps, before and after washing with sodium hypochlorite. Sampling was performed with a sterile swap in the transport medium. Samples were incubated for 3 h and were cultured on blood agar and eosin methylene blue agar. After overnight incubation and colonization, the identification was conducted using macroscopic, microscopic, rapid enzymatic, and biochemical tests.

The most common bacterium before washing was Pseudomonas aeruginosa and the least common was Enterobacter cloacae. It was revealed that sodium hypochlorite exert the most profound effect on Pseudomonas aeruginosa, whereas the least effect was detected on Staphylococcus aureus and Staphylococcus epidermidis.
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The type of bacteria involved in nosocomial infections could be different among hospitals. Sodium hypochlorite 5% is recommended for washing hospital gowns to reduce bacterial contamination.

Branchial cleft cyst abnormalities account for approximately 20% of congenital neck and head abnormality. There are four types of branchial cleft cyst. The incidence of type one is 8 percent, type two 95%, type three 2% and type four 1 to 4 percent with just 100 reported cases. Type four is reported very rarely in previous investigations and the patient in this survey appears to belong to this type. Also one of the differential diagnoses of the thoracic inlet masses can be considered the branchial cyst Type  IV, which can occur in the fifth decade without any presentation according to our experience in this case in spite of the fact that previous studies which revealed its incidence in the second  to fourth decade of life. Branchial cleft cysts are diagnosed according to MRI and CT scans that in this case the diagnosis is based on a CT scan. The choice treatment for branchial cleft is surgery. Relapse is scarce and imply that a piece of tract’s epithelial lining has remained and it is more common in the patients who suffered from infectious lesion.

Although foreign body ingestion is a frequent incident in children, it sometimes happens accidentally in normal adults or occurs intentionally in 10% of the cases due to psychological disorders. In spite of the recent increasing use of flexible endoscopy, there is still a position for the rigid endoscopy which is suitable for the tissue biopsy and foreign body extraction. Since the rigid endoscopy provides a wide-open space, it is regarded as a great advantage to remove sharp and keen foreign bodies from the esophagus.

Pituitary adenoma which is one of the most common brain lesions accounts for about 10%-15% of all central nervous system (CNS) tumors. The most common type of pituitary adenoma is prolactinoma which is responsible for 45% of pituitary tumors and considered the leading cause of hypogonadism and infertility. Prolactinomas are rare in children and more prevalent in girls, as compared to boys. In the present article, we describe the case of a boy with prolactinoma. Here we present a boy born on 31 March 2007 who referred to the endocrinologist with a complaint of frequent discharge of milky hydrorrhea from the left breast. The patient had been struggling with binge eating since he was 8 and he got overweight soon after. He gradually developed blurred vision; however, he did not have any complaint of headache and diplopia. The recent advances in diagnostic techniques and increased knowledge of pituitary adenomas have led to the timely diagnose of this disease. However, the achievement of such major goals requires physicians' meticulous attention to patients’ clinical symptoms, especially non-specific ones.