فهرست مطالب

  • Volume:1 Issue:3, 2012
  • تاریخ انتشار: 1391/07/15
  • تعداد عناوین: 10
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  • Sina Safamanesh, Abdolreza Pazouki, Zeinab Tamannaie, Behnoush Mohammadalipour, Koosha Ramezani, Esmaeel Hajnasrollah, Ghazal Hajnasrollah, Shahla Chaichian Page 90
    Background
    Small bowel obstruction is one of the most common surgical emergencies and main causes of hospital admissions. Diatrizoate Meglumine Gastrografin, a hyperosmolar water-soluble contrast agent, has been used to triage patients with small bowel obstruction for an operative or a non-operative management. It can also have a therapeutic effect by increasing the pressure gradient across obstructive sites that may result in resolving the obstruction..
    Objectives
    The aim of this study was to test the gastrografin effect in the resolution of small bowel obstruction..Patients and
    Methods
    In this cross sectional–descriptive study, gastrografin was given to patients diagnosed with small bowel obstruction in clinical and radiological grounds. The contrast passage was assessed by serial X-rays. If the contrast remained in the small bowel, a decision was made as to whether proceed to surgical intervention, based on clinical condition. The patients were divided into two groups: A, who finally required surgery, and B, who were resolved by gastrografin administration..
    Results
    Forty six patients were entered into the study. Thirty seven of the patients (80%) received a non-operative course in whom the contrast was observed in the large bowel. They had a mean hospital stay of 4.6 days. Nine patients (20%) required operative intervention. These patients had a mean hospital stay of 8 days..
    Conclusions
    This study has demonstrated that gastrografin was highly effective in the management of adhesive small bowel obstruction resulting in a decreased need for surgery and hospital stay.
    Keywords: Diatrizoate Meglumine, Intestinal Obstruction, Surgery
  • Mohammadali Pakaneh, Abdolreza Pazouki, Zeinab Tamannaie, Malahat Ansari, Khatere Masumi, Khadijeh Haidari, Masud Majed, Somayyeh Mokhber, Mohammad Rohani, Shahla Chaichian Page 94
    Background
    Meralgia paresthetica (MP) is a benign clinical syndrome of entrapment of the lateral cutaneous nerve in the thigh. Among the complications of bariatric surgery, neurologic complications are not uncommon and of these complications, MP is a frequent clinical diagnosis. Thus, knowing the clinical risk factors of MP is of great importance as they help with the differential diagnoses of MP from other serious disorders..
    Objectives
    To study the prevalence of MP and its clinical risk factors after bariatric surgery in a sample of Iranian morbid obese patients undergoing surgery for obesity.. Patients and
    Methods
    In a cross-sectional study, 163 patients (146 females and 17 males), who underwent bariatric surgery, were called one to 48 months after their surgery. After obtaining their consent, the patients were interviewed and completed a questionnaire containing history and presentation of neuropathy for this study. In addition, some of the variables of the questionnaire were filled using the patient’s medical records..
    Results
    One month after surgery, 32 patients (19.5%) had neurologic signs or symptoms of MP located in their lateral thigh. Diagnosis of MP was made in 21 (17 women and four men) patients (12.8% of all patients), sub-acute polyneuropathy in seven patients (4.3%), and acute polyneuropathy in the remaining four patients (2.4%). No specific treatment was given to the patients with MP. Symptoms of MP were resolved within six months in 15 patients (71.4%). In a univariate analysis of MP, only a history of a neuropathy was significantly correlated with the occurrance of MP after surgery (P = 0.004) with an odds ratio of 4.2 (95% confidence interval: 1.4-12.2)..
    Conclusions
    MP is not a common complication after bariatric laparoscopic surgery, however, a history of neuropathy and diabetes should be mentioned to surgeons as risk factors for MP. Additionally, using a belt for fixation could be a an etiologic factor for MP after bariatric surgery.
    Keywords: Meralgia paresthetica, Bariatric Surgery, Complication, Neuropathy
  • Ahmadreza Soroush, Zhamak Khorgami, Yosra Jahangiri, Roza Mofid, Shirzad Nasiri, Ali Aminian, Abbas Alibakhshi Page 99
    Background
    Trocar site, incisional hernia is one of the serious complications of laparoscopic surgery. As a result, many surgeons prefer to close the fascia, especially in those sites where a trocar of 10 mm in size or larger has been inserted. On the other hand, suturing the fascia may lead to damage of other tissues, such as the intestines; hence, some surgeons prefer not to close the fascia.
    Objectives
    This study was performed to evaluate the outcome of using fascial non-closure in sites of 10 mm ports and the incidence of subsequent incisional hernia in patients undergoing laparoscopic cholecystectomy..Patients and
    Methods
    The current study was a cohort scheduled for surgery in the General Surgery Ward at the Shariati Hospital of the Tehran University of Medical Sciences. Two hundred and twenty patients were selected in a convenient manner for a cholecystectomy. A 10 mm trocar was inserted in the umbilicus and the other ports were 5 mm. None of the trocar sites was closed. All of the patients were followed up to one year after the operation..
    Results
    The mean age was 43.41 years and 91 patients (41.4%) were male. Five patients (2.3%) developed incisional hernia. The occurrence of hernia was not associated with; age, sex, BMI > 25, smoking or diabetes (P > 0.05)..
    Conclusions
    According to the results obtained in this study, it seems that in cases without closure of the fascia site of 10 mm trocars, the incidence of incisional hernia is considerable. Furthermore; age, gender, weight, smoking or diabetes, did not have any relationship with the occurrence of incisional hernia. More comparative studies are required to confirm these results.
    Keywords: Hernia, Ventral, Cholecystectomy, Laparoscopic, Abdominal Wound Closure Techniques
  • Mohammad Kazem Shahmoradi, Morteza Khavanin Zadeh, Zeinab Tamannaie, Mohammad Vaziri Page 103
    Background
    The invention of central venous catheters (CVC) for hemodialysis (HD), brought about a fundamental change in the treatment of patients who needed HD, from the late 1970’s till the present time. Nowadays the use of CVC is a common medical procedure. Increasing use of these methods necessitates clarification of the exact nature of the effects, and potential complications for surgeons..
    Objectives
    This study attempts to determine the frequency of CVC; complications, survival rates and outcomes in HD patients, treated at the Hasheminejad Kidney Center, Tehran from January 2010 till June 2011..Patients and
    Methods
    In this cross-sectional descriptive study, we collected data (using the census method) from the records of all patients over the age of 18 years, who had been referred, from January 2010 till June 2011, for CVC insertion. Catheter sites, related complications, creatinine (Cr), hemoglobin (Hgb), survival rate of catheters and the patients’ demographic data, were collected and analyzed..
    Results
    In this study, 150 patients were evaluated, 122 participants (81%) were male and 28 (19%) were female. The patients’ average age was 56.2 ± 5 years (19 to 87 years). Regression analysis between the patients, with and without complications, showed that increasing age (P = 0.003, RR = 0.78), decreases in Hgb (P = 0.04, RR = 0.34) and also increased Cr (P = 0.023, RR = 0.45), and BUN (P = 0.014, RR = 0.37) are significantly correlated with catheter-related complications as independent risk factors. The one month survival rate of temporary catheters was 77.3% and their two-month survival was 60%.
    Conclusions
    The overall rate of complications in the present study was no higher than in other similar studies. Anemia rates, however, were much higher in our patients. Most of the complications involved catheter infections, followed by catheter thrombosis. CVC survival rates in Iran have an acceptable outcome and results of this study were similar to those of past studies.
    Keywords: End Stage Renal Disease, Hemodialysis, Central Venous Catheter, Complication
  • Godratollah Maddah, Abbas Abdollahi, Ali Jangjoo, Sadjad Noorshafiee, Mohsen Abdollahi, Ali Mohammad Hasanzadeh Page 108
    Background
    Catheterization of central veins is a routine technique which is widely used in general hospitals and medical intensive care units. It should be carefully performed and managed to prevent adverse side effects..
    Case Presentation
    In this case report, we describe a case of lost guide wire during central venous catheterization, which was successfully treated with a minimally invasive surgical technique..
    Conclusions
    Inattention is the main cause of the retained guide wires. The interventional angiography is usually successful as the first line therapy.
    Keywords: Catheters, Catheterization, Central Venous, Surgical Procedures, Minimally Invasive, Complications
  • Rahul Kumar Gupta, Paras Kothari, Abhay Gupta, Ritesh Ranjan, Krushna Kumar Kesan, Kedar Mudkhedkar, Niyaz Mohammed, Parag Karkare Page 111
    Background
    Omental cysts are rarely intra-abdominal pathology. We report a case of omental cyst successfully resected by laparoscopy using two ports only with excellent outcome.
    Case Presentation
    Our patient was a seven year old girl who presented with complaints of lump in abdomen, in which laparoscopy aided in making a correct final diagnosis and the surgical management. Preoperative diagnostic work-up included Ultrasonography and Computed Tomography scan (CT scan) of abdomen which revealed huge intraabdominal cystic lesion of unknown origin. Extensive diagnostic workup did not reveal the etiology of his problem. Diagnostic laparoscopy led to the correct diagnosis and appropriate surgical treatment with complete relief of his complaint. Histopathology of the excised specimen was suggestive of lymphangioma..
    Conclusions
    On six months of follow up, the patient is doing well and asymptomatic with no evidence of recurrence.
    Keywords: Laparoscopy, Omentum, Cysts, Pediatrics
  • Nobumi Tagaya Page 116
  • Markus Gass, Ralph Peterli Page 118