Medical Journal Of the Islamic Republic of Iran
Volume:21 Issue: 3, Autumn 2007

The retroauricular-temporal or Washio flap has been introduced forreconstruction of partial nose and cheek defects, and has many advantages. We decidedto evaluate the extended use of this technique in order to repair full thicknessnasal defects. Superficial temporal and retroauricular arteries are identified withDoppler flowmetry. Selection points A, B, C and D are delineated. Point Ais the pointaround which the entire flap rotates, and is a fixed point in front of the anterior end ofthe helix and behind the superficial temporal artery. The next step is the selection ofpoint C for the flap to reach the defect.We operated 8 cases utilizing this method to reconstruct alar and columellar defects with chondrum. We found this technique very useful. The advantages of this techniqueinclude suitable flap color, good texture, no need for microsurgery experience, donorand recipient sites for surgery are in one field, and the donor site scar is inconspicuous. We find this technique very effective in repairing total subunit (nasaltip) defects. To fully appreciate it, we have to expand the distal part of the flap by including conchal cartilage with it.

Thyroglossal duct cysts (TDC) are the most common congenital neck masses arising from the expansion of the epithelial tract remnants occurring during embryogenic thyroid migration. About 7% of the population have thyroglossal duct remnants. Clinical presentation is frequent in children, but adults can also present with thyroglossal duct cysts. Thyroglossal duct cysts may rarely develop carcinomas (1-1.6 %)but tend to occur more in adults than children. We retrospectively reviewed all cases of TDC carcinoma surgically treated during a 15-years period at Ahwaz Emam Hospital center. Three patients (two female and one male patient), who were 23 to 46 years old (mean 38 yr.) were identified. The frequency of TDC carcinoma among surgically removed TDC cysts was 0.7%. Amidline upper neck mass was the initial symptom in all patients. The diagnosis of cancer was made after the Sistrunk’s procedure in all three cases. All patients had papillary carcinoma. Thyroid involvement was noted in one case. One patient had near-total thyroidectomy, and two received postoperative radioactive iodine. After a mean follow-up of 11 years (range: 1 to 15 yr.), no patient hada documented local recurrence or distant metastatic involvement, and no tumor-associated mortality was observed. Although development of a papillary thyroid carcinoma from thyroglossal cyst is very rare, it should be born in the mind of the surgeon and the pathologist that this possibility exists and the ductal wall should be examined elaborately.

To present the changes in projected thoracic hypokyphosis and the behavior of lumbar lordosis within and below the fusion and to compare these changes between the Harrington rod (HR) and posterior multisegmented hook instrumentation. 178 patients with idiopathic scoliosis, who had undergone posterior spinal fusion with Harrington technique (106 patients) or multisegmented hook system (72 patients), were analyzed. The average coronal plane correction was 37% with the Harrington technique and 54% with the multihook system. In sagittal plane correction and in thoracickyphosis in patients treated with HR technique, the preoperative thoracic hypokyphosisbecame normal in 20% of cases, remained unchanged in 60% and deteriorated in 20% ofcases. Normal preoperative thoracic kyphosis did not increase in any of the cases. Thethoracic kyphosis in patients treated with multihook technique became normal in 66%,remained unchanged in 17% and deteriorated in 17% of cases. Normal preoperativethoracic kyphosis remained the same post-operatively in 92% and changed to kyphosisin 8% of cases. Of 38 cases with decrease in total lumbar lordosis, 33 cases showed decrease,and 5 cases remained unchanged postoperatively concerning lumbar lordosis atthe fusion level. The effect of the multihook system to correct coronal plane deformities was markedly better than the HR system (53.8% vs. 37.9%).

Esophageal replacement is indicated in certain circumstances including long gap esophageal atresia, severe strictures due to gastro-esophageal reflux(GER) and caustic burns. We analyzed our results of 18 patients who underwentesophageal replacement in our university hospital. We reviewed esophageal replacements carried out in our departmentbetween June 1996 and August 2004. We report 18 patients (4 girls and 14 boys) withages ranging from 3.5 until 30 months. Fifteen patients had long gap atresia, two hadstrictures due to GER, and one case had caustic burn. Esophageal replacement wasperformed through an abdominal midline incision by one of three methods, namely:colon transposition in 15, gastric replacement in 2, and gastric tube in 1 case. Leakage and stricture were the most common complications ofesophageal replacement. Most deaths were due to aspiration pneumonia and congenitalcardiac disease. Esophageal replacement has limited indications. It allows a goodfunctional result, with adequate oral feeding and normal growth.

Mustard gas, lethal in high doses, affects multiple organs such asskin, eye and respiratory system. We studied the development of late onset mustardinduced polyneuropathy among chemically wounded Iranian veterans. In this descriptive study, 100 chemically wounded Iranian veteranswith severe eye involvement were examined for any signs and symptoms ofpolyneuropathy by an internist. 20 patients were suspected to have neurologicalsymptoms or signs. These patients were examined by a neurologist again. 13showed abnormal neurological symptoms. Electrodiagnostic exams were performedfor this group by another physician. 13 veterans had abnormal neurological exam results with prominentsensory signs and symptoms in almost all of them. Brisk deep tendon reflexes werefound in 3 cases. Electrodiagnostic studies were compatible with axonal type distalsensory polyneuropathy in 6 subjects. To the best of our knowledge, this is the first report of late onsetpolyneuropathy among chemically-wounded victims who were exposed to mustardgas. The pathophysiology of this form of neuropathy is still unknown. Unlike mosttoxic neuropathies, obvious clinical signs and symptoms appeared several years afterexposure. No specific treatment for polyneuropathy due to chemical weaponsexposure has been described to date.

End-to-side esophagojejunostomy has almost always been associated with some degree of dysphagia. To overcome this complication we decided to perform an end-to-end anastomosis and compare it with end-to-side Roux-en-Y esophagojejunostomy In this prospective study, between 1998 and 2005, 71 patients with a diagnosis of gastric adenocarcinoma underwent total gastrectomy. Standard esophagojejunostomy with an end-to-side fashion was performed in 41 patients and compared with our recommended technique of end-to-end esophagojejunostomy in 30 patients. This study showed that esophagojejunostomy with an end-to-end fashion has a low incidence of postoperative dysphagia (33.3%), whereas in those with an endto- side anastomosis the rate of dysphagia is very high (83%). A Roux-en-Y esophagojejunostomy with an end-to-end anastomosishas a low incidence of postoperative dysphagia and we strongly recommend using thistechnique.

The optimal therapy of acute iliofemoral venous thrombosis is still amatter of debate. The purpose of our study was to evaluate the late results of iliofemoralthrombectomy with regard to the prevention of the development of a PostThrombotic Syndrome (PTS). During 2000-2003, 18 patients underwent transfemoral venousthrombectomy for acute iliofemoral venous thrombosis. 16 patients were reexaminedafter a 5-year follow-up. At follow-up, the patency of venous segments as well as thedevelopment of reflux was investigated by duplex-ultrasound. Furthermore, clinicalsigns and symptoms of PTS in patients were recorded. Clinical pulmonary emboli did not occur in the perioperative period. Twopatients died because of disseminated metastatic cancer and another after massiveretroperitoneal bleeding due to anticoagulation therapy. In a 5-year follow up, 31%had valvular reflux. Venous patency rate was 75%. The rate of PTS was 37.5% withoutthe severe form of PTS. Patients did not have healed, healing, and/or active venous ulcer. It is thought that vein patency and valvular function were relativelyrestored, and PTS was prevented after surgical thrombectomy. Vascular surgeonsshould include venous thrombectomy as a part of their routine operative armamentarium,offering this procedure to patients with iliofemoral DVT, especially if other optionsare not available or have failed.

This study sought to determine patient characteristics, process ofcare, and outcome as predictors of reintubation after open-heart surgery. We performed a retrospective case control study that included all patients undergoing cardiac surgery who required reintubation and an equal number of control patients not requiring reintubation. Putative risk factors were analyzed univariately by Moses, Kroskal Willis and χ2 tests. Of the 300 consecutive patients reviewed, 39 required reintubation for cardio- respiratory reasons. Univariate predictors of reintubation (P= 0.05) were preoperative CO2, ejection fraction, weight, diabetes, and intra-operative fluid balances. Multivariate predictors of reintubation for each group (with cardio-respiratory reasons) andfor all patients were determined and included preoperative PaCO2, type of operation,ejection fraction (EF), pre- operative PaO2, number of grafts, age, intra-aortic balloonpump, pump time, clamp time, pH at extubation time, and PaO2 at extubation time. Patients who required reintubation had the worst respiratory function.Patients identified as having high risk factors for reintubation should be followedclosely and treated for problems that will lead to reintubation.

We report a case of paint thinner intoxication by inhalation, with rhabdomyolysis, renalfailure, skin lesions and severe sciatic nerve lesion at gluteal region.

Liver neoplasm is not an uncommon disease in Asian countries. Liposarcoma is arare mesenchymal malignant tumor which usually originates in the retroperitoneumand extremities. From 1973 till now about 10 cases of primary liver liposarcoma havebeen reported. We present the eleventh case in a young adult female with uncommonpresentation. She suffered from a huge mass in the right portion of the liver with clinicalmanifestations of sepsis and respiratory distress. Despite aggressive surgery, tumorrecurrence after six months led to death after a year. Hepatectomy is the best strategyto achieve long term survival for patients.Trials of preoperative radiation therapywith or without intraoperative irradiation are underway.