Journal of Surgery and Trauma
Volume:2 Issue: 2, Autumn 2014

Nowadays, spinal anesthesia is associated with few complications in many surgical practices especially the elective caesarean which is taken as a suitable replacement for general anesthesia. Different drugs are used for spinal anesthesia. This study aims to compare lidocaine 5% in combination with meperidine 5% plus lidocaine 5% for spinal anesthesia in non-emergency cesarean patients. This is a double-blind clinical trial that Was performed on fifty full term pregnant women, physical status I or II, presenting for non-emergency cesarean section under spinal anesthesia were randomly divided into two groups with 25 in each. All patient received IV 15 ml/kg Ringers solution 15 minutes prior to block. For spinal anesthesia, patients were given either 5% Meperidine 1.25 mg/kg or 5% heavy Lidocaine 60-75 mg intrathecally. The sensory blockade in all except two patients in Lidocaine group and one patient in Meperidine group, who required sedation and analgesia during surgery, was adequate for cesarean section. Data were analyzed by spss software. Post-operation analgesia duration was 342.5±18.5 minutes in the lidocaine plus meperidine group and was 131.6±15 minutes in the lidocaine group. The mean difference of blood pressure before and 15 min after blockage was not significant in the lidocaine group and lidocaine plus meperidine group. It seems that lidocaine-meperidine combination has stronger medical effects than lidocaine used alone. Besides, the combination can be a proper drug for spinal anesthesia given the longer analgesia duration and lack of significant complications for the patient or adverse effects on the baby.

Bacterial translocation is defined as the passage of bacteria from intestinal tract to the extraintestinal organs such as the peritoneum and blood circulation. The aim of this study is to examine bacterial translocation (regarding type of bacteria and effect of time of obstruction on bacterial translocation) from intestinal lumen to the peritoneum and viscera in acute, simple mechanical, small bowel obstruction in rats. In this cohort study, thirty female Wistar rats were divided into three groups with two subgroups, each sub-group containing 5 rats. The 1st group consisted of two sham-operated and non-operated control subgroups. The 2nd group was the IO-24 group, and the 3rd group was the IO-48 group in which the interval between producing intestinal obstruction and the second laparotomy was 24 h and 48 h respectively. Each subgroup was divided into two subgroups of partial and complete obstruction. The data was analyzed using Fisher’s exact test and K2 test in SPSS. The most common types of bacteria were E. coli in aerobic culturing and bacteroid in anaerobic culturing. However, as the time of obstruction increased, the pattern of bacterial translocation changed to anaerobic bacteria. Our study showed that with increased time of obstruction, pattern of bacterial translocation changed from aerobic to anaerobic. Enterococci were the most common type of bacteria in an aerobic group.

Detection of malignant cells in the peritoneal cavity indicates the extension of cancer cells. The aim of this study is to evaluate the incidence rate of positive cytology in colorectal cancer and its relationship with the local progress of the tumor. In a 2-year prospective study in Mashhad and Iran Universities of Medical Sciences, peritoneal lavage was performed on 40 patients with colorectal cancer from May 2012 to May 2013. Before any manipulation of the abdominal cavity, about 100 cc of normal saline was entered into the peritoneal cavity. Then, the samples were submitted for cytology. A sample was considered as positive if at least one cancer cell was detected. From among 40 patients, 19 were male and 21 were female. The mean age of the patients was 51 years. They consisted of 17 cases of colon cancer and 23 cases of rectal cancer. Totally, positive cytology was identified in three patients. Among them, one case had abdominal carcinomatosis and the other two cases were involved at the levels of T3 and/or T4. It appears that peritoneal cytology is an appropriate method to evaluate tumor staging. Results of this method can be correlated between positive cytology and peritoneal seeding and survival, although the result of negative cytology cannot exclude advanced colorectal cancer and patients with carcinomatosis may have a negative peritoneal lavage.

Despite advances in cardiac surgery, many patients might still encounter some post-surgical complications and difficulties. To overcome such difficulties, they should receive the required education. In view of the fact that determining the educational needs is the first step in educational planning, the present study aims to determine the educational needs of patients undergoing heart valve replacement. This descriptive-analytic study was conducted cross-sectionally during the summer of 2012. The questionnaire was designed by the researchers and covered demographics and knowledge assessment sections (in four categories including the nature of diseases, different types of artificial heart valves, drugs and nutritional diets, and the activity level). The validity of the questionnaire was checked based on content validity and its reliability was calculated 0.89 by Chronbach''s alpha. Participants were between 15-80 years of age. Their surgery was performed in the last 3 years. The data was analyzed in SPSS (version 16.0) using descriptive statistical tests (mean and standard deviation), t-test, and ANOVA. The significance level was set at P<0.05. The finding showed that the highest mean score belonged to the knowledge of the nature of the disease whereas the lowest one, to the knowledge of drugs. As regards to the nature of the disease, there was a significant relationship between educational needs of the patients and their gender (P=0.01), age (P=0.02), education (P=0.005), and marital status (P=0.01). As for the knowledge of drugs, there was a significant relationship between gender and education. On the contrary, there was no significant relationship between the patients’ educational needs and previously-received trainings. Based on the results of the current study and the changing needs of the patients, nurses should perform needs analysis before starting any educational program. Moreover, by designing a well-organized program and investigating the patients before they leave the hospital, nurses should ensure that such a basic need is met. The findings of this study can help nurses to identify the educational priorities of patients undergoing heart valve replacement.

As a key member of the healthcare workforce, nurses play an important role in patient care. N ursing care performance, especially sterilization, is of significant importance in provision of health and prevention of complications such as hospital infections. This study aimed to investigate nurses’ performance concerning sterilization while performing nursing techniques in ICU wards of educational hospitals affiliated to Birjand University of Medical Sciences. In this descriptive-analytic study, 36 nurses working in the ICU ward were selected by census method. A researcher-made observational checklist with three choices for each item was designed to check the sterilization techniques used by nurses in terms of obtaining intravenous (IV) access (10 items), suctioning of the endotracheal tube (7 items), and dressing (8 items).For each technique, a total score of≥75% was considered as good, between 50-75% as moderate, and <50% as poor performance. Content validity was used to confirm the validity of the checklist, and Cronbach’s alpha was calculated 0.67 to confirm its reliability. Data were analyzed in SPSS (version 16) using independent t-test at the significant level of P<0.05. Mean score in the suction technique (out of 21) was 15.3±0.88 for which 8.3% of participants had good and 91.7% had moderate performance. As for the dressing technique, the mean score (out of 24) was 18.1±0.68 for which 46.4% of participants had good and 53.6% had moderate performance. Mean score in the obtaining IV access (out of 30) was 18.64±1.03 for which 100% of participants had moderate performance. No poor technical performance was observed, nor was there a Significant differences between the participants’ demographics and their performance. Nurses’ performance concerning sterilization techniques used in the ICU wards was moderate. Considering the results, periodic re-education programs are suggested to improve nurses’ performance.

Causes of death vary globally, and they depend regionally on lifestyle and socio-cultural factors. The purpose of this study was to determine accident-related mortality in Southern Khorasan Province, Iran, in the year 2010. This descriptive-analytical study involved all the death cases in the year 2010 in Southern Khorasan. The data were collected from the death registration system, and were classified and analyzed according to the codes of the 10th revision of the International Classification of Deaths (ICD). From among the 3,792 deaths in 2010, n=633 (16.7%) were accident-related. Of accident-related deaths, 73.6% (n=450) of the deceased persons were male. The highest rate of mortality belonged to Summer (July 23 to Aug 22) (n=203; 32.1%). The median age in accident-related deaths was 36.6±21.9 years with the minimum age of 5 days and maximum age of 92 years. The leading cause of mortality was traffic accidents (52.1%) and violence (18%). The median age of the deceased women in accidents was significantly higher than men (P<0.048) and in rural persons more than urban people (P=0.02), with Surgical complications as the least frequent cause of death. Since road traffic accidents rank first in accident-related mortality, it is recommended to have measures to improve road safety as well as quality and safety of vehicles, and to establish strict rules for those who disobey traffic rules.

Prevalence of stroke following coronary artery bypass graft surgery (CABG) is % 2.1-5.2 and associated with high mortality. The purpose of this study was to investigate the prevalence of carotid artery disease in patients undergoing CABG surgery. This cross-sectional study was performed in the years 2010-2011 on 192 patients who underwent open heart surgery (CABG) in Imam Reza Hospital in Mashhad. Questionnaires with items about demographic data, risk factors, and outcome of coronary angiography were completed by participants. Carotid Doppler ultrasonography was performed by a radiologist for all the patients, and the data were analyzed in SPSS (V: 15) using chi-square and t-test at p<0.05. In this study, 192 patients (116 male and 76 female) with the mean age of 60.3 ± 10.82 were examined. The prevalence of 50% carotid stenos was 26.6%. Carotid stenosis was found to be directly and significantly related with age and severity of coronary artery disease. Given the high prevalence of carotid artery stenosis in patients with coronary artery disease, evaluation of carotid arteries in patients undergoing CABG is very important, especially in case of old age and severe coronary lesions.

Rhabdomyomata are probably the most common tumors that occur very rarely during infancy. In this paper, we report the case of a 49-day-old infant who was diagnosed by echocardiography examination with left ventricle outflow tract (LVOT) obstruction caused by rhabdomyoma. The infant underwent surgical approach, and her mass was shaved. Finally, she was discharged from hospital in good general condition. Six-month follow-up after the operation did not show any obstruction.