فهرست مطالب

نشریه جراحی ایران
سال بیست و هشتم شماره 3 (پاییز 1399)

تاریخ انتشار: 1399/09/30
تعداد عناوین: 10

فارسی
English

انتخاب همه

Acute Abdomen - in Special and Comorbid Cases

Jalali S. A* Pages 1-11

The term acute abdomen became popular in the beginning of the last century, and it meant that the surgeon is faced with an abdominal event or surgical abdomen that needs emergent surgery, and morbidity and mortality dramatically increased if surgery postponed. During the years better paraclinical and laboratory modalities became routine, and the surgeons were able to diagnose the event exactly and act accordingly in most usual cases; so the old saying “open and see, rather than wait and see” became less reliable. Since acute abdominal conditions has more or less the same clinical and Paraclinical Signs and Sympatoms; the present article is meant mostly to deal with special cases in patients with comorbidities, because due to their compromised immune response, the clinical and laboratory findings has not changed pathological. These special conditions includes children, elderlies, morbid obese, diabetics, renal failure, postoperative cardiac patients and comorbidities as well as heavy smokers, alcohol and substance abusers; and last but not least patient with severe immune deficiency like HIV and the like; which needs special attention and frequent clinical and paraclinical evaluation for proper decision making.

Keywords: Acute Abdomen, Surgical Abdomen, Abdominal Pain, Abdominal Events in Immunocompronised

Abstract View Paper Research/Original Article Original: Persian
Determining the Results of Graft Patency in Femoroiliac Venous Bypass with Venous Allograft in Patients with Chronic Venous Ulcer

Hasani M, Beigi Brogeni A, Soleymani A, Bakhshaei P*, Fazel I Pages 12-20

Introduction & Objective

Chronic venous disease of lower limb is one of the most common diseases. The primary treatment for chronic venous disease is non-surgical. Surgical treatment used in cases where endovascular techniques fail, or endovascular option is not possible. The grafts used in the venous system are much more likely to develop thrombosis. ePTFE is the best choice for replacing large veins with prosthetic grafts. In this study patients with chronic venous insufficiency and active ulcer (C6) in the field of iliac and femoral vein occlusion that were candidate for venous bypass and in these patients, the use of autologous vein was not possible and instead of using of ePTFE, The harvested iliac vein was used as a conduit.

Materials & Methods

This is a case study in which patients with chronic venous insufficiency and active wound (C6) in the field of iliac and femoral vein occlusion who are candidates for venous bypass surgery while the use of autologous vein was not possible and Instead of using PTEF, the iliac vein is used as a conduit. Five patients were enrolled in intravenous bypass with allograft of brain-dead patients and were evaluated for graft patency, wound healing, limb edema and patient satisfaction within one year.

Results

The patency rate graft after one year was two out of five cases (40%), while the wound in four patients after one year had complete healing (80%). Two patients had no edema and mild edema (40%) and three had moderate edema. There was also relative satisfaction in patients with thrombosed grafts. Although three of the grafts were thrombosed in the sixth month, the wound in these patients was completely healed in two cases and one was significantly healed, indicating that a six-month graft patency was sufficient to heal the wound.

Conclusions

Complete and significant recovery of patients, even in cases that were present after six months of stenosis, indicated that the initial opening of the wound for six months is sufficient for wound healing. Also, due to wound healing, edema and patient satisfaction, the use of this type of allograft is recommended, especially in infectious patients. However, due to the lack of a control group, it is recommended that a larger study be performed if a sufficient number of patients are available.

Keywords: Graft Patency, Femoroiliac Venus Bypass, Allograft

Abstract View Paper Research/Original Article Original: Persian
Clinical Guidelines for the Prevention of Venous Thromboembolism in Neurosurgery

Saberi H*, Rahmani Tanha R, Derakhshanrad N, Yekaninejad M. S, Sheikhrezaei A. R Pages 21-46

Introduction & Objective

The prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing neurosurgery is reported to be up to 25%. Mortality from this complication has been reported between 9% and 50% due to PE. Even with the use of pneumatic pressure devices, the prevalence of DVT is reported to be up to about 32% in these patients, so prophylactic treatment with heparin is of particular importance. Application of low molecular weight heparin (LMWH) reduces the prevalence of DVT by 40-50% in neurosurgery patients. Our neurosurgeon must strike a balance between the risk of venous thromboembolism (VTE) and the increased risk of bleeding from heparin prophylaxis for DVT and pulmonary embolism. The aim of this study was to provide clinical recommendation for prevention of VTE in neurosurgical cases.

Materials & Methods

Here we try to review the available scientific sources on the prevalence and risk factors for VTE in neurosurgery patients and up-to-date recommendations and guidelines for mechanical (Intermittent pneumatic compresion and anti-embolic stocking) and pharmacological (low-dose unfractionated heparin or LMWH) prophylaxis of VTE in patients with neurosurgery.

Results

Strength of panel opinion (including 6 neurosurgeons) assessed by the weights of each risk factor for thromboembolism during and after cranial and spinal surgery was calculated. The risk factors with less than 50% of the panel opinion were excluded. At last the results were inserted within evaluation forms for each risk factor. Measuring level of agreement (kappa coefficient) between 6 persons of expert panel for evaluating risk factors during and after cranial and spine surgery was calculated.

Conclusions

In all neurosurgery patients, mechanical prophylaxis should begin at the time of admission and continue for up to 30 days if immobilized, or until the person is mobilized. Drug prophylaxis also increases the effectiveness of mechanical prevention and should be considered in patients at high risk for VTE.

Keywords: Venous Thromboembolism, Deep vein Thrombosis, Prevention, Guideline, Neurosurgery

Abstract View Paper Research/Original Article Original: Persian
Relationship between Acute Gastric Dilation and Loss of Consciousness in Trauma Patients

Ebrahimian M*, Shadidi Asil R, Kialashaki M, Zamani A, Hajinasrollah E. Pages 47-54

Introduction & Objective

Trauma is one of the most common causes of death in the world. Acute gastric dilation (AGD) and its associated complications in trauma patients have been relatively less studied. The aim of this retrospective study was to find out more about the prevalence of AGD in high-energy trauma patients and its potential relationship with loss of consciousness.

Materials & Methods

177 high-energy trauma patients, who were eventually managed in ICU, were selected and AGD was evaluated in these cases. Age, gender, consciousness level using Glasgow coma scale (GCS), and AGD presence were analyzed to test the hypotheses.

Results

The studied sample included 157 (88.7%) male and 20 (11.3 %) female patients making a total of 177 out of which 22 expired in the hospital. Age range was between 3 month to 88 years(Mean = 34.4). Prevalence of AGD was 62.1% and a moderate negative relationship was found between GCS and acute gastric dilation (n = 153, P = 0.000).

Conclusions

Results of the analyses show that there is a negative relationship between AGD and GCS meaning that patients with lower GCS experience a higher risk of AGD. The highest incidence rate of AGD was found in patients with a GCS score of 13 and 14 and it was only observed in 17 out of 51 patients with a GCS of 15. Thus we concluded that a mild decrease in GCS can potentially lead to AGD. Furthermore, there was a mild negative relationship between age and AGD meaning that older patients have a higher chance of developing AGD.

Keywords: High-energy Trauma, Acute Gastric Dilation, Aspiration Pneumonia, GCS

Abstract View Paper Research/Original Article Original: Persian
Study on Total Protein and Serum Albumin in Acute Burn Patients in Motahharie Burning Hospital due to 2016-2017

Jafarian A. A*, Alizadeh Otaghor H. R, Jafarian M<Karimi Estahbanati H, Momeni M, Jafari A. R, Jafarian Z Pages 55-62

Introduction & Objective

Evaluation of losing albumin and total protein in acute burning patient’s plasma important on prognosis on burning side effects. The aim of this study is the detection of total protein and albumin in acute burn patient's serum.

Materials & Methods

In one cross-sectional study during12 month on 1396-1397 with simple method, 130 patients with age greater than 15 years old and the burning surface of 10-70% in Motahharie burning hospital was evaluated to serum total protein, albumin, BUN, and level of albumin to creatinine, data analysis was done with SPSS and soft ware version, 23 and for quantified subjects t-test with means and standard deviation and for quantified subjects chi-square-test with variation ± 0.05.

Results

Mean level of serum's albumin, total protein, BUN, albumin to creatinine (ACR) in acute burning patients was respectively: 3.36±1.12, 5.14±0.46, 24.44±5.80, 0.89±0.14, 3.36±1.24 mg/dl. Inverse correlation to the percent of burn with serum albumin level (correlation coefficient equal -0.154) and total protein of serum (correlation coefficient equal -0.546, with) and ACR (correlation coefficient is -0.192. In addition, a direct Correlation coefficient on the percent of burn and BUN were seen 0.336 mg/dl .For allabove, P = 0.002.

Conclusions

Hypoalbuminemia and Hypoproteinemia in acute burning patients is noticeable and direct relation with severity and surface of burning and two this injury were seen.

Keywords: Acute Burning, Hypoalbuminemia, Hypoproteinemia

Abstract View Paper Research/Original Article Original: Persian
Comparison of Patients Pay out of Pocket before the Health Reform Plan and thereafter in Patients of Hazrat Fatima (SA)

Akbari H*, Emami S. A, Akbari P, Malaie L, Bagheri Faradanbe H Pages 63-72

Introduction & Objective

Measuring financial support is determined by the amount of out of pocket payment for receiving health services. The aim of this study was to compare the amount of patients out of pocket payment for medical expenses before and after its health reform plan.

Materials & Methods

This study is cross-sectional that was done in two time periods before and after the healthcare reform plan in Hazrat Fatima hospital affiliated to University of Medical Sciences, Iran. The data collection tool was a researcher-made checklist and data analysis was done using the spss program.

Results

After implementation of the health reform plan in patients under study, there was an increase in the cost of treatment items for patients, including hoteling costs, labs and anesthesia. Also, after implementation of the health reform plan in patients under study, there was a decrease in the cost of treatment items for patients, including the cost of diagnostic imaging, medicine, rehabilitation, surgery and other expenses.

Conclusions

Based on the plan for the development of the health system of the country, all drugs, equipment and consumables of medical patients will be provided by the hospital. Hospitalized patients will not be guided to these items outside of the hospital, which can be attributed to the reduction of treatment costs in the plan of development Health system. In the event of sustained resources and commitment by the government to reduce the health costs of the population, the necessary ground should also be provided by the Ministry of Health and the country's insurance and health insurance funds in order to improve the quality of the desirable service delivery. And the level of satisfaction of all citizens, as well as the quality of services with quantitative indicators, should be constantly monitored and the conditions for increasing the efficiency and efficiency and commitment to the medical profession should be improved every day.

Keywords: Out of Pocket Payment, Health System Development Plan, Hazrat Fatima Hospital

Abstract View Paper Research/Original Article Original: Persian
Bilateral Tubal Ectopic Pregnancy

Fallaharzpeyma S, Sazgara F*, Saffari E, Mansour Ghanaie M, Aghazade A Pages 73-77

When a fertilized ovum implants outside of the uterine cavity is known as ectopic pregnancy. Bilateral Tubal Ectopic Pregnancy is one of the most uncommon types of ectopic pregnancies and its incident is higher in women using reproductive techniques and early detection of that is extremely important because of associated morbidity and mortality. A 33 years woman with previous history of ectopic pregnancies was admitted due to amenorrhea and abdominal pain. She had undergone IUI 28 days before admission. In Transvaginal ultrasound we found heterogeneous masses in both adnexa, suspicious for bilateral ectopic pregnancies. Color Doppler ultrasound exam showed peripheral vascularity in both masses. Surgical findings following laparoscopic bilateral salpingectomy were two non ruptured ectopic pregnancy masses in ampullary parts of both fallopian tubes. Histopathological findings confirmed the diagnosis of bilateral ectopic pregnancies. In women with history of previous ectopic pregnancy and infertility, even if unilateral ectopic pregnancy is considered, checking contralateral adnexa carefully by TVS to exclude bilateral ectopic pregnancy is essential and could prevent physicians from facing urgent challenges and decrease the risk of maternal morbidity and mortality.

Keywords: Ectopic Pregnancy, Infertility, Abdominal Pain, Pelvic Mass, Trans Vaginal Ultrasound

Abstract View Paper Case Report Original: Persian
Heart Coronary Scafollds Biocompatibility

Sadeghabadi A*, Sadrnezhaad S. K, Hassanzadeh Nemati N, Asefnejhad A, Najmoddin N, Ghasemi M Pages 91-105

Heart-Artery disease are major cause of deaths in industrialized and high-stress countries. Coronary artery atherosclerosis to be the most common cause of morbidity and mortality. Stent invention for CAD treatment was very effective that easily Percutaneous coronary interventions (PCI), including percutaneous transluminal coronary artery angioplasty (PTCA) and coronary artery stenting (CAS). Coronary stent included metallic scaffold with advance drug therapy. This stents known drug eluting stents (DES). Use of DES remove of limitation of ballon angioplasty but Frist generation of drug eluting stents decrease of in-stent restenosis effectively but delay significantly recovery. In the other hand this stents susceptibility of late thrombosis. This problem led to clear long term clinical complications Therefore, despite obtained improvements, coronary stents still remained no biocompatible with artery. This review about coronary stent improvement and modification methods that decrease of thrombosis and restenosis. Also the latest progress about coronary implants design that have good biocompatible was offering.

Keywords: Coronary Artery Disease, Biocompatibility, Restenosis, Stent, Thrombosis

Abstract View Paper Research/Original Article Original: Persian

علمی مصوب

نشریه جراحی ایران

Iranian Journal of Surgery

فصلنامه پزشکی

آخرین شماره | آرشیو

ISSN: 1735-4099

صاحب امتیاز:

جامعه جراحان ایران

مدیر مسئول:

دکتر ایرج فاضل

سردبیر:

دکتر مصطفی جابرانصاری

تلفن نشریه: ۰۲۱-۲۶۷۵۵۴۱۱

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فهرست مطالب

نشریه جراحی ایران سال بیست و هشتم شماره 3 (پاییز 1399)

نشریه جراحی ایران

Iranian Journal of Surgery

نشریه جراحی ایران
سال بیست و هشتم شماره 3 (پاییز 1399)