نشریه جراحی ایران
سال سی و یکم شماره 1 (بهار 1402)

The use of burning substances is common in our country. Burns caused by the ingestion of caustic substances are potentially one of the most debilitating injuries of the industrial, which can place a great burden on the patient and the health system.To diagnose and treat these patients, it is necessary for surgeon from different fields to cooperate, including surgeons, gastroenterologists, otolaryngologists, and radiologists. Delay in the diagnosis and treatment of full-thickness necrosis of the esophagus and stomach is one of the important factors in the prognosis of patients In fact, the amount of delay in surgery can be considered as a predictor of mortality in these patients. Ingestion of caustic substances leads to tissue damage within the first few seconds. At the beginning of the disease, bleeding, thrombosis and inflammation with edema are the dominant tissue processes. Severe burns can lead to focal areas of necrosis with the risk of perforation. Routinely, after conducting preliminary investigations and in the absence of clear signs of respiratory distress and clinical symptoms of the neck, chest and abdomen, it is recommended to perform an endoscopy in the first 24 hours, and based on the results of the endoscopy, the necessary treatment decision is made. The diversity in the existing guidelines in this field and the relatively uncommon occurrences in medical centers are the reason for the lack of a fixed protocol in the treatment of these patients. For this reason, treatment methods in many centers are different from each other.

The aim of this study was to determine the effectiveness of hydrocolloid dressings containing silver in the treatment of wounds in the donor area of partial thickness skin seizures.

This randomized clinical trial was conducted on 42 patients who needed partial thickness skin grafts for skin defect reconstruction. After removing the skin graft, the patients were randomly assigned to two groups of hydrocolloid dressing containing silver with Aquacel Ag brand (intervention group) and traditional dressing group (control group). Patients were visited on days 3, 7, 5 and 7, 14 and 21. In each visit, the frequency of dressing change, wound infection, pain during dressing change, the rate and speed of the epithelialization process, and the scar of the wound site were also compared in the two groups at the end of the sixth month. The collected data were analyzed using SPSS version 24 software.

The results showed that there was a statistically significant difference between the average number of times the need for dressing, the degree of epithelialization of the wound, in the two groups of hydrocolloid dressing with silver and traditional dressing (P-value < 0.05); However, there was no statistically significant difference between the mean prevalence of infection, pain during dressing change, vascularity, pigmentation and scar thickness in the two groups of hydrocolloid dressing with silver and traditional dressing (P-value < 0.05).

Overall, the results of this research showed that Aquacel Ag is a safe and effective method for managing the wound in the donor area of partial thickness skin grafts.

Accurate diagnosis of bone structure and disease severity in patients with hallux valgus is crucial. Therefore, this study aims to investigate the correlation between the hallux valgus angle and other radiological angles and indices in patients with hallux valgus deformity.

This cross-sectional analytical study was conducted from 2021 to 2022. The study population consisted of patients with hallux valgus deformity. First, basic demographic information of participants was documented, then, a standing dorsoplantar foot radiograph was performed for all patients. Radiological information of the patients, including hallux valgus angle, the first-second intermetatarsal angle, the first-fifth metatarsal angle, the first metatarsal length, the ratio of the length of the first metatarsal to the second, and the horizontal distance between the distal of the first and fifth metatarsals were measured. In addition, to evaluate the clinical severity of hallux valgus, macroscopic photographs were taken from the patients in the same position using a digital camera. Four expert physicians evaluated the photographs separately and blindly based on the visual analogue scale (VAS) index. The VAS score ranged from 0 to 10, with 0 representing the minimum disease severity and 10 representing the maximum deformity in hallux valgus. The relationship between variables was investigated using Pearson's correlation coefficient and a linear regression model.

In this study, 110 patients (94 females and 16 males) were enrolled, of which 80 patients (72.8%) had a moderate hallux valgus, and 30 patients (27.3%) had severe hallux valgus based on the clinical severity of hallux valgus (VAS). The results of the Pearson correlation and linear regression model showed that the hallux valgus angle had the highest positive correlation with the first-fifth metatarsal angle (correlation coefficient of 0.55 and P < 0.001), the first-second intermetatarsal angle (correlation coefficient of 0.52 and P < 0.001), and the ratio of the length of the first metatarsal to the second (correlation coefficient of 0.24 and P = 0.01).

The results of this study revealed that some radiological indices correlate with the hallux valgus angle and, consequently, the disease severity. These findings highlight the importance of considering these factors in patients' radiographs and during corrective surgeries.

Laryngoscopy in women with severe preeclampsia is one of the most stressful anesthesia events; Laryngoscopy can stimulate hemodynamic responses in these women and lead to serious complications; Therefore, it is necessary to choose a safe method for laryngoscopy of these women; the aim of this study is to investigate the safety of Glidescope versus Macintosh blade in tracheal intubation for cesarean delivery in women with severe preeclampsia.

In a controlled prospective clinical trial, 70 pregnant women with severe preeclampsia candidates for cesarean section under general anesthesia were randomly assigned to one of the two groups of 35 Glidescope or Macintosh. Before induction of anesthesia, hemodynamic monitoring including heart rate, pulse oximetry, invasive arterial blood pressure was established. Tracheal intubation was performed in two Glidescope or Macintosh groups with the help of a Glidescope or Macintosh laryngoscope. Hemodynamic parameters were recorded 2 minutes before induction of anesthesia, before laryngoscopy and 1, 2, 3, 4, 5 and 10 minutes after tracheal intubation and compared between two groups.

High blood pressure in the first 5 minutes after intubation was more common in the Mackintosh group (P-value < 0.05). The rate of successful intubation was the same in both groups. The success rate in the first attempt was higher in the glidescope group (88.6% vs. 77.2%). The time required for intubation was longer in the Glidescope group (32.6±50.2 vs. 44.1±29.7 seconds, P - value = 0.03). The rate of airway complications was the same in both groups.

In airway management for cesarean section in a patient with severe pre-eclampsia, intubation with Glidescope, although it requires more time, creates a more acceptable hemodynamic situation than Mcintosh blade; It should be noted that the rate of airway complications is the same in the two groups; Therefore, safety of laryngoscopy with gladoscope in cesarean delivery of women with severe preeclampsia is acceptable.

Stoma surgery is a life-changing experience that poses many challenges in the patients' life. Accordingly, these people have to adjust with the new lifestyle for better management of their conditions. Therefore, the present study was conducted to assess the adjustment of patients with ostomy and the related factors.

In this descriptive - correlational study, 130 ostomy patients who referred to 4 educational hospital of Isfahan University of Medical Sciences, were selected through convenience sampling. The data were collected by Simmons Ostomy Adjustment Inventory-23 (OAI-23) and a demographic-medical information form and then analyzed with using descriptive (frequency, percent, mean and standard deviation) and inferential statistics (independent t-test, ANOVA and regression analysis) by SPSS (v.15). The significance level of the tests was considered 0.05.

The mean score of adjustment with ostomy was 47.83 ± 17.211. Among the different dimensions of adjustment, the highest and lowest mean score were related “acceptance” and “anger”, respectively. Also, based on our findings the relationship between adjustment with ostomy and some of demographic-medical factor include gender (P = 0.022), marital status (P = 0.005), living status (P = 0.000), education level (P = 0.019), and Job (P = 0.001), duration of having stoma (0.032) were statistically significant.

According to the moderate level of adjustment in these patients, it is need to conduct further investigations to identifying other related factors as well as appropriate psychosocial interventions to improve their adjustment with the ostomy.

Considering that in previous studies, the role of depression before surgery with chronic and acute pain after surgery has not been accurately reported and the contribution of this psychological factor to pain (acute and chronic) after breast cancer surgery is unclear, the purpose The purpose of this study is to determine the effects of depression before surgery on acute and chronic pain after breast cancer surgery.

This study was conducted as a systematic review and meta-analysis. Searching for articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Iranian Mag and SID databases with keywords "pain or chronic pain or acute pain or pain after surgery" and "depression" and "breast cancer, breast surgery" , breast" was done. Forest and funnel plots were used to analyze the results.

The results indicated that the relationship between pre-surgery depression and short-term pain intensity (7 days to 3 months) (0.03-0.45) CI 95%: 0.24 - 59%- = I2 and P = 0.12), pain three to six months after surgery (0.07-23) 0.15: CI95% - 70% = I2 and P ≥ 0.01) and chronic pain (12 months) (0.12-22 0.17: CI95% - 28% I2 and P = 0.19 are significant.

Depression before surgery increases the risk of acute and chronic pain after surgery.

Gastric cancer, a significant global health concern, presents unique challenges when it occurs within families due to potential genetic predisposition. This article presents a case series of three gastric cancer cases in a family and discusses their clinical characteristics, management, and outcomes. The first case involved a 35-year-old female patient who underwent surgery with no recurrence during follow-up. The second case, her younger brother, experienced recurrence and post-op complication leading to death. The third case, their mother, presented with metastatic gastric cancer. The article emphasizes the rarity of hereditary gastric cancer and the need for further research and guidelines in its diagnosis and treatment. Genetic testing's role in identifying familial gastric cancer remains uncertain but warrants improvement in disease management, family monitoring, and preventive interventions.

Disinfectants and Anti septics have been used by humans for a long time. The discovery of alcohol by Razi is a main step in it was the knowledge of disinfectants that continues to this day. Getting to know the types of disinfectants and choosing the best ones it is one of the essentials in today's world. Because of the importance of saving human lives in medical surgeries, Medical services and epidemics require the use of disinfectants for vital people. In addition, Anti septics to clean the hospital environment, equipment and surfaces are required. Alcohols, betadine, savlon, hydrogen peroxide and advanced hybrid disinfectants are examples of common disinfectants. Sodium hypochlorite, deconex, phenol, Formaldehyde, glutaraldehyde and orthophthal aldehyde are used as Anti septics. After finding Covid-19, the importance of advanced disinfectants became clearer. In the field of advanced technical disinfectants The K20 and K21 with high safety and efficiency were formulated and made by an Iranian researcher who soon They will replace foreign goods. This article first describes the types of disinfectants, Anti septics and specialized terms Discusses the related. Then to introduce advanced disinfectants for hospital and Corona control Viruses are effective. Creation of technical knowledge and production of them is very necessary.

Medical privacy and maintaining patient confidentiality is a must which is rooted in absolute moral and customary principles, and is the cornerstone of the trust between the physician and the patient. Therefore, it is supported by laws and considered as one of the prominent aspects of medical law. Violation of patient confidentiality will lead to legal prosecution. This descriptive study was carried out with the aim of investigating the nature and the dimensions of disclosing patients' confidential information in the context of medical law, and explaining the exceptions and the related decrees with a critical approach to the current legal system. The findings showed that the primary rules governing medical relations is the necessity of maintaining patient confidentiality, and commission of crime and criminal responsibility in case of disclosing patients’ confidential information. However, in accordance with public peace and social interests, certain exceptions have been made by the current laws and customs (emergency cases) as the justifiable factors of crime against this rule, which have made the reporting confidential and medical information as a legal obligation for the physician. It seems that by relying on the criterion of "adequate support" instead of focusing on "maximum support" in regard with maintaining patients' confidential information, it is necessary to stipulate the law on the exceptional cases of disclosing patients' confidential information and update the existing laws with regard to the emerging issues and illnesses. In addition, more attention should be paid to clarifying confusion and ambiguity, and creating legal transparency and coherence.