فهرست مطالب
Medical Journal Of the Islamic Republic of Iran
Volume:20 Issue: 4, Winter 2007
- تاریخ انتشار: 1385/10/11
- تعداد عناوین: 12
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Page 158BackgroundThe cosmetic result of the surgical scar has long been consideredby surgeons as an important factor for patient satisfaction. On the other hand, there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth.MethodsIn this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis, we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.ResultsThere was no significant difference in the rate of wound infectionbetween these two groups.ConclusionsThis study shows that perfect closure of the wound with subcuticular closure, which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.
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Page 161BackgroundThrombosis will occur due to contact of blood with unepithelializedsurfaces after vascular clamping and also blood stasis during vascular surgery. Heparin is administered to prevent thrombosis. The aPTT test is used for assurance of the anticoagulative effect of heparin. At the end of the operation heparin is neutralized by protamine sulfate in some centers. In this study we assessed the necessity of aPTT and the use of protamine during vascular surgery.MethodsIn this case-control survey 154 cases of vascular surgery were dividedin to two groups, while the groups were matched regarding age, underlying disease and for vascular complications during the first postoperative 24 hours. In group A (62 cases), aPTT was determined after 2 minutes of heparin administration but heparin was not neutralized by protamine at the end of the operation.In group B (92 cases), aPTT was not determined after heparin administration but heparin was neutralized by an appropriate dose of protamine at the end of the operation.ResultsComplications were seen in 4 cases of vascular surgery (2.6 %):right leg embolus in 1 case (0.65 %), spinal ischemia in 1 case (0.65 %), neuropathyin 1 case (0.6%) and hypotension due to protamine in 1 case (0.65 %). 3 cases were from group Aand 1 case was from group B, but differences were not statistically significant although the power is high enough (power=70%).ConclusionAccording to our findings it seems with appropriate techniquesand accomplishing surgical principles, there is no need for aPTT assessment andprotamine administration. This can reduce the cost and duration of operation, itscomplications, and prevent adverse reactions to protamine.
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Page 166BackgroundSeveral studies have examined the reflex response of ankle musculature to sudden inversion in noninjured and injured subjects. To date, there havebeen no studies to determine the effect of versatile degrees & conditions of perturbationon the ankle musculature latency. The purpose of this study was to measure and determine whether there was a difference in ankle musculature latency measurementsat 10°, 20°, and 30° in the oblique plane on a dual tilting platform (APS) between normal and functionally unstable ankles under different conditions of perturbation.MethodsThe musculature latency of 15 healthy subjects (8 females, 7 males;age range, 18 to 30 years) and 15 patients with functional ankle instability (FAI) (8females, 7 males; age range, 18 to 30 years) were examined with surface EMG aftersudden inversion of the ankle by APS.ResultsIn all angles of the oblique plane, the latency of Peroneus longus, Tibialis anterior, Peroneus brevis, and Soleus were significantly longer in subjects withunstable ankles under expected and unexpected conditions. Unexpected conditionsled to increase the latency of ankle musculature, both for normal and functionallyunstable ankles.ConclusionThe significantly longer onset and peak latency of ankle musculatureduring sudden inversion in the standing position in subjects with unstable ankles is explained by proprioceptive deficit in sensorimotor control of functionally unstable ankles. Unexpected external perturbations of body equilibrium elicit compensatory postural reflexes which cause longer latency of ankle musculature during varying angles of perturbation.
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Page 175BackgroundTranspupillary thermotherapy is a new treatment for subfovealchoroidal neovascularization which needs further evaluation. This study was aimed to evaluate the efficacy of transpupillary thermotherapy on regression of occult subfovealchoroidal neovascularization with or without pigment epithelial detachment in patients with age-related macular degeneration.MethodsIn a case series study, patients with age-related macular degenerationwho had occult subfoveal choroidal neovascularization less than 4 disc diameterswith or without pigment epithelial detachment underwent transpupillary thermotherapyby diode laser. The patients were followed for 1-12 months. Main outcome measures were visual acuity changes, flattening of pigment epithelial detachment observed clinically, or absence of leakage in angiography. The data were analyzed using T-test and chi- square.ResultsThe study included 30 eyes of 30 patients. Mean age of the patients was 67±7 years. Mean follow up time was 5.3±0.5 months. Visual acuity improved in63%, remained unchanged in 20%, and worsened in 17%. Mean visual acuity improvedfrom 1.25±0.4 log MAR (20/320) to 1.06±0.36 log MAR (20/200), (p<0.04). Choroidal atrophy or flat scar was achieved in 73% and failure to treatment was seen in 27%, (p =0.0001). Pigment epithelial detachment flattened in all cases after transpupillary thermotherapy.ConclusionTranspupillary thermotherapy may be a particularly useful modalityfor treating occult subfoveal choroidal neovascularization associated with serouspigment epithelial detachment in selected cases of age-related macular degeneration.
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Page 181BackgroundOsteoporosis is a major public health threat, and hip fracture is a serious consequence of osteoporosis. Apatient with an osteoporosis-related hip fracture has an increased risk for a second hip fracture. The effect of osteoporosis management on the risk of recurrent hip fracture was evaluated in this study.Methods58 hip fracture patients older than 50yr and BMD < 2.5 were discharged from hospital with Ca-Vitamin D- Alendronate prescriptions, and followedup for 4 years to determine the rate of recurrent hip fractures. Rate of second hip fractures was compared with 58 hip fractures in the control group (without osteoporosis treatment) which were also followed for 4 years.Results72% of patients continued treatment for 2 years. There were no second hip fractures in the critical first 12 months in the treated group. Overall secondhip fractures in osteoporosis treated and control groups were 3.4% and 8.6%(p<0.03), respectively.ConclusionManagement of hip fractures in the elderly should include bonemineral density determination and osteoporosis treatment to prevent further fractures.
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Page 184BackgroundThe aim of this study was to determine the auditory performanceof congenitally deaf children and the effect of cochlear implantation (CI) on speechintelligibility.MethodsAprospective study was undertaken on 47 children in a pediatric tertiary referral center for CI. All children were deaf prelingually and were younger than8 years of age. They were followed up until 5 years after implantation. Auditory performance was assessed by using the categories of auditory performance (CAP) scaleand speech intelligibility rating which evaluated the spontaneous speech of eachchild before and at frequent intervals for five years after implantation.ResultsPre-lingually deaf children showed significant improvement in auditoryperformance after implantation. Six months after implantation 91% of children hadthe ability to respond to speech sounds. At the end of year one, 96% of childrencould discriminate speech sounds and 84% of children who reached the three yearinterval could understand common phrases without lip-reading. After cochlear implantation, the difference between the speech intelligibility rating increased significantlyeach year for 3 years (p<0.05) and did not plateau up to 5 years after implantation.The changes in auditory performance and speech development were parallel.ConclusionThe results indicated the ability of cochlear implantations to significantly improve auditory receptive skills and subsequently speech development inyoung congenitally deaf children.
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Page 192BackgroundAdjacent treatment fields are commonly used in external beam radiation therapy, such as mantle and inverted-Y fields for the treatment of Hodgkin’s disease and craniospinal fields used in the treatment of medulloblastoma and head and neck tumors when the lateral neck fields are placed adjacent to the anterior supraclavicular field. In each of these situations, there is a possibility of introducing very large dosage errors across the junction. Consequently, this region is at risk for severe complications if it is overdosed, or tumor recurrence if it is underdosed.MethodsFor prevention of adjacent field overlapping a new method is introduced. In this method the patient’s couch of the treatment machine is rotated for90º clockwise and counterclockwise. Then the gantry is rotated for α and β that are measured by geometrical methods in opposite direction for each field. The adjacent fields have a common edge and then the overlap region in treatment volume is eliminated.ResultsBy phantom dosimetry, the maximum dose in the junctional volumeof the two adjacent treatment fields is measured to be 102%. This technique providesan inhomogeneity of about 2%.ConclusionIn some cases, the measurements have shown that the dose inhomogeneity is as large as 45%. Compared with the dynamic intensity-modulatedradiotherapy (IMRT), this technique also provides a superior dose homogeneity such that inhomogeneity becomes about 2%.
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Page 198BackgroundLymphoproliferative disorders are among the most serious and potentially fatal complications of chronic immunosuppression in kidney transplant recipients. The principle risk factors for development of PTLD are the degree of overall immunosuppression and the EBV serostatus of the recipient. In this study, the risk of PTLD in kidney transplant recipients who received Anti- Lymphocyte Globulin (ALG) or Anti Thymocyte Globulin (ATG) was evaluated.MethodsWe retrospectively studied 520 patients who underwent kidneytransplantation during the period from December 1989 to December 2002, atTaleghani Hospital, Tehran.Results369 patients received classic immunosuppression (prednisolone, cyclosporine, mycophenolate mofetil) and 151 patients (29%) received classic immunosuppression with ALG or ATG. Eight patients had developed PTLD, 5 casesof which (62.5%) received classic immunosuppression without ALG or ATG. Incidenceof PTLD was 3.3 percent in patients who received ALG or ATG and 0.8 percent for those patients who did not receive ATG or ALG. This difference is very significant (p < 0.05).ConclusionALG or ATG therapy could act as a risk factor for PTLD.
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Page 205Alvelolar hydatid disease is caused by E. multilocularis. Human infection occurs at the larval stage of this small tape worm (1.2 to 4.5 mm). In this article we studied alveolar hydatid disease in a 50 year old woman who presented with a hepatic mass. Liver biopsy and histopathologic evaluation showed alvelolar hydatidosis of the liver. Then resection of the left lobe of liver was done, with medical treatment with oral Albendazole (15 mg/kg/12h) for 6 weeks with 2 week intervals. The drug was continued for 4 courses. 5 year follow up of the patient was satisfactory without any complaint.
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Page 208Acute inflammation of the gallbladder can occur without gallstones. Acalculous cholecystitis typically develops in critically ill patients in the intensive care unit. Patients on parenteral nutrition, with extensive burns,sepsis, major operations, multiple organ trauma or prolonged illness with multiple organ system failure are at risk for developing acalculous cholecystitis. The association of acalculous cholecystitis with Mirizzi syndromeis very unusual. Mirrizzi syndrome, which is an unusual cause of obstructive jaundice, is most commonly caused by a stone impacted in Hartmann’s pouch, exerting pressure over the common bile duct (CBD) with subsequent erosion into the CBD. The case we are presenting is a case of Mirrizi syndrome type-1 due to acalculous cholecystitis in a 13-year-old girl that presented with intermittent jaundice and RUQ abdominal pain and fever. Intraoperative finding showed Mirizzi syndrome type- 1 without gallstones. The cause of jaundice was only pressure of the gallbladder on the CBD and cholecystectomy with intraoperative cholangiography was performed. At post operative follow-up, the patient became anicteric and all symptoms and signs disappeared.
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Page 212We report a 30 year old woman who presented with a painless preauricular mass of two months duration. Superficial parotidectomy was performed for the patient. Histological examination and immunohistochemical findings were in favor of mixed cellularity Hodgkin’s lymphoma (MCHD). According to this diagnosis the patient received local radiotherapy and during 4 months of follow-up no recurrence was seen. To our knowledge only one such case has been reported in the English literature to date by Uchinuma in 1988.
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Page 215Fat necrosis secondary to pancreatitis can be either mild and self limited or create severe organ damage, but may rarely lead to abdominal opancreatic pseudotumor. We report a case of fat necrosis secondary to pancreatitis which clinically simulatestransverse colon cancer.