نشریه جراحی ایران
سال بیستم شماره 4 (زمستان 1391)

Introduction & Hemodialysis (HD) is the most common substitute procedure for renal transplantation which is done so far for patients at the end stage of renal disease (ESRD). The arteriovenous fistula (AVF) remains the ideal vascular access for HD patients. Limited studies for evaluation of the effect of inflammatory process on the AVF failure have been done. The aim of our study was to investigate the effect of inflammatory markers in the early failure of the fistula. In this descriptive cross-sectional study، 87 ESRD patients with AVF surgery were enrolled and followed for 1 month for early failure and complications. The analysis was performed using SPSS v. 18. Data related to age، gender، complications، Hemoglobin، AVF site، ESR& CRP were entered in a check list for each patient. Results are shown as the mean and Standard deviation (SD) for quantitative variables and percentage for qualitative variables and compared using standard statistical tests such as Independent Samples T-test، Mann-Whitney-U and Chi-square tests. P value less than 0. 05 was considered as significant The mean age of patients was (55. 9±16. 8) years; there was a male preponderance (73%). 93% of AVFs were created in the left arm، all in radiocephalic anastomosis. The most frequent complication seen in our patients was thrombosis (8%). Our results showed that the frequency of failure was higher among patients with positive CRP (P)

Introduction & The high mortality rate of mesenteric ischaemia is mainly due to delay in diagnosis. For this reason، it is of great importance to find a specific and rapidly elevating marker. In this study we evaluated the role of plasma D-dimer level in early diagnosis of the acute mesenteric ischemia in rats، caused by ligation of superior mesenteric artery. This was a randomized clinical trial. Forty mature male Wistar albino rats were used in the study. These were divided into four groups، each consisting of ten rats. In group I، after performing a simple laparotomy، blood was sampled at first hour. In group II، after laparotomy the superior mesenteric artery was ligated، and after one hour the blood samples were taken. Group III consisted of rats undergoing a simple laparotomy and blood samples were taken 6 hours later. In group IV blood samples were obtained 6 hours after the ligation of their superior mesenteric artery. Basal D-dimer levels were determined in the all groups before laparotomy. For the analysis of variables Mann-whitney and wilcoxon methods were used. The plasma D-dimer level of the ligated groups were significantly higher both at the 1th hour and the 6th hour after ischemia than the level of those who had undergone simple laparotomy (P)

Introduction & In recent years، base deficit of plasma has been used as a marker to determine the status of tissue perfusion and predict the outcome in trauma patients. This study was performed to investigate the effect of plasma base deficit in predicting the burn patients'' outcome. This prospective cohort study was done in the acute phase of burn patients from October 2008 to October 2009 who were admitted hospital of Motahary in less than 6 hours after injury. Patients based on the mean plasma base deficit in the first 24 hours after injury، were divided in two groups: group A (mean plasma base deficit lesser than or equal to -6، and group B (mean plasma base deficit more than -6). Statistical analysis was performed، using SPSS 16 software. In each group، 38 patients were enrolled. The mean plasma base deficit in group A (-7. 76 ± 2. 18 mmol) was lesser than that of the group B (-1. 19±2. 82 mmol) (P=. 031). Although there were no significant differences in the mean volume of fluid resuscitation and urine output in first 24 hours after injury between the two groups (P=. 030)، and despite removal of interfering factors، there were significant differences between systemic inflammatory response syndrome and multiple organ dysfunction syndrome score and the percentage of sepsis between two the groups (P)

Introduction & Due to cartilage weakness، the tension produced by scars، and congenital soft tissue defects، repairing cleft lip nose deformities (CLND) can present itself as a challenge. These lesions could be neutralized by a strong reinforced scaffold، such as rib cartilage، to keep the nose in its new position. In this study two groups of patients were chosen for CLND repair using autologus grafts. In group one، we used septal and ear cartilage for all modifications، and in group two، septal and rib grafts were used for the same purposes. Patients’ pictures، before and after the procedure، were reviewed by two independent surgeons and categorized as: worse، better، good and excellent. The results were compared، using the Mann-Whitney test. Comparing the postoperative results in the two groups، showed that using rib cartilage can be significantly beneficial for CLND cases (P ≤ 0. 05). The authors believe that rib cartilage serves as a strong scaffold in CLND repair and is associated with minimal complications.

Introduction & The neutrophil-lymphocyte ratio test has extensive application in diagnosis of appendicitis، but its accuracy has some contraversies. According to the importance of this disease and to determin the efficiency of this test، this study was done on adults who referred to Shahid Beheshti hospital of Kashan in 2008، with diagnosis of appendicitis. In this descriptive-analytic study، blood for measurement of CBC & diffrentiation was collected pre-operatively from 106 patients. The patients according to the histopathology of the appendix were divided in two groups; to positive (acute and complicated Appendicitis) and negative (normal) and the ratio of Neutrophiles to Lymphocits، compared in two groups. In this study، 106 patients with suspicious diagnosis of acute appendicitis were studied. Out of a total 106 patients، 94 patients (88. 7%) had positive appendicitis. WBC count was 12798±4181 mm3 in positive appendectomies and 10561±5699 mm3 in negative group (P=0. 03). Neutrophil percent was 80±36 % in positive group and 66 ±11% in negative group (P=0. 005). Lymphocyte percent was 15±9% in positive group and 24 ±11% in negative group (P=0. 013). Neut/Lym ratio percent was 7±5 in positive group and 4 ±3 in negative group (P=0. 01). Neut/Lym ratio /8% were males and 38. 1% were females، Male to female ratio being 1. 6:1. On histological examination، 86. 9% had acute appendicitis whereas 13. 1% had normal appendix. Sensitivify، Specificity، Positive predictive Vulue and negative predictive value of Neut/Lym ratio test was respectively: 74%، 67%، 94%، 25% the area under the ROC Curve was 0. 730. The Neut/Lym ratio test، in spite of significant difference doesn''t have necessary efficiency in diagnosis of acute and complicated appondicitis.

Factor XI deficiency، called Hemophilia C، and in comparison with hemophilia A and B، it causes a more unpredictable bleeding، which has no correlation with the blood level of Factor XI. These patients often do not encounter hemorrhagic events، unless they encounter trauma or surgery. This article reports the case of a 52 years male patient that had no known history of clotting disorders، pelvic hematoma formation، following a rectal cancer surgery. In order to assess the caused prolongation of coagulation test Aptt، factor XI deficiency was confirmed. The patient was treated with factor VIla and FFP and bleeding was controlled.