Canon Journal of Medicine
Volume:1 Issue: 2, Spring 2019

One of the most important problems of premature infants and main reason of hospitalization in neonatal intensive care unit (NICU) is their low birth weight. They need gavage for feeding which has several side effects. Thus choosing appropriate nutritional interventions in premature infants decreases gavage-related complications and results in lower duration of hospitalization. In this clinical trial study premature infants were randomly allocated to two intervention and control groups. Both groups underwent routine care. Intervention group infants received abdominal massage 15 minutes twice a day for five days by a trained physiotherapist using moisturizing lotion based on the method described in previous studies. Eventually 28 infants (15 male and 13 female) with a mean gestational age of 32.43±1.16 weeks in intervention and 33±0.88 weeks in control group underwent analysis (p=0.15). Mean gastric residual volume was 0.71±1.13 ml in intervention and 1.43±1.55 ml in control group prior to intervention (p=0.2). It was 1.93±2.43 ml in intervention and 4.71±4.25 ml in control group in the fifth day of intervention (p=0.04). Before intervention, mean weight was 1830±330 gr in intervention and 1870±370 gr in control group (p=0.82). In the fifth day of intervention mean weight was 1871±323.15 gr in intervention group and 1767±347.24 gr in control group (p=0.001). In conclusion our findings suggest that abdominal massage efficiently decreases gastric residual volume and helps with weight gain in preterm infants.

The apnea of prematurity usually occurs at the end of the first week of life in premature infants. In most cases, apnea of premature infants occurs when they reach the appropriate age to be born. The present study aims to compare the effectiveness and adverse effects of caffeine with aminophylline on apnea of prematurity in infants. The present clinical trial has been conducted on 64 premature infants. They were hospitalized in the NICU of Najmiyeh Hospital and divided into 2 groups. 30 infants received a loading dose of 5mg/kg aminophylline followed by a maintenance dose of 1.5mg/kg 3 times a day while 34 infants received a loading dose of 20 mg/kg caffeine followed by a maintenance dose of 5mg/kg once a day. Clinical symptoms and complications of infants, mechanical ventilation time, length of stay and frequency of apnea during treatment were gathered. Eventually 64 premature infants were investigated (p=0.185). Mean of gestational age in infants who received caffeine (group A) was 31.27 weeks and in infants who received aminophylline (group B) was 31.07 weeks (p=0.806). The mean duration of mechanical ventilation was 2.78±1.43 days in group A infants. This was 2.57±1.53 in group B infants. .Mean duration of hospitalization was 18.42±17.18 days in group A and 14.50±9.86 days in group B (p=0. 582).there was no significant difference between caffeine and aminophylline in decreasing apnea attacks (p=0.428). There was no significant difference in decreasing apnea attacks, length of stay and mechanical ventilation time between the two groups.

Solitary plasmacytoma is an uncommon type of plasma cell dyscrasia, which might occur in bone or soft tissue.  Soft tissue solitary plasmacytoma or extramedullary plasmacytoma is less frequent than bone plasmacytoma. The most common location for extramedulary plasmacytoma is nasopharynx and paranasal sinuses. Oropharyngeal plasmacytoma is very rare; hence we would like to share our experience. The patient was a 57 year-old man with 2 months history of dysphagia with a foreign body sensation. Total tumor resection was done and he received 40 Gy radiation. After 24 months of follow up the patient was well and disease free. according to the presented case, a plasmacytoma should be considered in patients with dysphagia and oropharyngeal lesion. These masses can be treated with surgical excision and radiotherapy.

Cochlear implantation (CI) surgery is a choice treatment of bilateral profound hearing loss. The most common infectious complications are meningitis, otitis media, surgical site infection and mastoiditis. The aim of current study is to show the prevalence of infectious complications after CI surgery. In this cross-sectional study, all of the profoundly deaf patients who underwent CI surgery during two years from March 2015 to July 2017 entered to the study and were followed up for 6 months after surgery. All of the complications and documents were recorded in a pre-designed checklist. Finally, 364 Patients were enrolled to the study. The mean(± SD) duration of surgery was 2.3±1.5 hours. The complications after surgery occurred in 30 (8.2%) cases. The most common complication after CI surgery was otitis media followed by surgical site infection, meningitis, and mastoiditis. We found that otitis media is the most prevalent infectious complication after CI surgery. This study showed a significant increase in incidence of otitis media in 4 to 5 year-old children in comparison with other age groups.

Determining distribution of war injuries and the related mechanisms could provide attitudes in order to lower risks and expenses of war injuries as well as mortality. Ear injuries are of a high importance among battle-related injuries because of their dramatic impressions on quality of life of militants. So we aimed to determine the mechanism and type of ear injuries among Iranian veterans during Iraq-Iran war. In this cross-sectional study 207 cases of Iranian veterans with ear injuries during the Iraq-Iran war have been evaluated retrospectively between June and September 2016. We included veterans with ear injuries in association or absence of other organs injuries, randomly. Frequency and mechanism of injuries were recorded as well as chief complaints of patients. Mean, standard deviation and percentages were determined by descriptive analysis. Eventually 207 male veterans with mean age of 52.18±5.28 years were included in the study. Mean duration of war participation was 2.60±1.91 months. Shock wave was the most prevalent mechanism of injury with 202(97.6%) cases followed by direct bullet injury 3(1.4%) and blast injury (0.5%). Decreased hearing and vertigo were the most common (83%) chief complaint of patients followed by decreased hearing alone (56%) and tinnitus (2.9%). Our findings showed that decreased hearing is the most prevalent pathology among Iranian veterans with ear injuries during Iraq-Iran war. Tinnitus did not comprise a remarkable part of chief complaints. Also we found that shock wave is the most prevalent mechanism of ear injury.

Tracheal stenosis may have congenital or acquired causes. Depending on the severity of the stenosis and its symptoms, the right treatment is selected. Sometimes resection of the stenotic segment and anastomosis of the two ends is the therapeutic option. There are several techniques for anastomosis. In this article, while reviewing articles on how the sutures are used in the tracheal anastomosis, we explain the method applied in this study to use simple interrupted sutures without the use of multiple hemostats. An adapted and simplified suturing technique is described which has been successfully implemented in 30 patients. End-to-end anastomosis using "simple interrupted sutures without using multiple hemostats", has minimal complexity and stress for the surgical group with similar results.

Neuroendocrine tumors are classified as rare tumors that are mostly seen in lung or gastrointestinal tract and can cause many specific sign and symptoms such as flushing, diarrhea, heart failure, tachcardia, emesis and bronchoconstriction. In this case, the tumor is located in gallbladder with classic presentations.

A 59 year-old female attended to our clinic with nausea and vomiting, heartburn, weight loss and flushing. The patient’s ultrasound showed a hypo echo and heterogenic mass (24×36 mm) in the anterior wall of gallbladder which continued to the common hepatic duct and the CT scan reported a 40×21 mm mass like lesion in porto-hepatic area with pressure effect on distal of gallbladder and cystic duct suspicious for lymphadenopathy. The postoperative pathological findings were compatible with typical perineural carcinoid tumor.

Carcinoid or neuroendocrine (NETs) tumors are a type of slow growing tumors that are typically originated from several places of the body and usually begin in gastrointestinal (GI) tract or lung. Carcinoid tumor is a rare GI tract disease which consists about 1% of GI tract tumors. The NETs of gallbladder are very rare. This is necessary for surgeons to consider rare types in order to conduct proper management for this condition.