ABSTRACT
Free radicals generated by ionizing radiation attack various cellular components such as lipids. The lung is a very radiosensitive organ and its damage is a dose-limiting factor in radiotherapy treatments. Melatonin [MLT], the major product of the pineal gland acts as a radioprotective agent. This study aims to investigate the radioprotective effects of MLT on malondialdehyde [MDA] levels and histopathological changes in irradiated lungs. In this experimental study, a total of 62 rats were divided into five groups. Group 1 received no MLT and radiation [unT], group 2 received oral MLT [oM], group 3 received oral MLT and their thoracic areas were irradiated with 18 Gy [oM-R], group 4 received MLT by intraperitoneal [i.p.] injection and their thoracic areas were irradiated with 18 Gy [ipM-R], group 5 received only 18 Gy radiation in the thoracic area [R]. Following radiotherapy, half of the animals in each group were sacrificed at 48 hours for evaluation of lipid peroxidation and early phase lung injuries. Other animals were sacrificed in the eighth week of the experiment for evaluation of the presence of late phase radiation induced lung injuries. Pre-treatment of rats with either i.p injection [p<0.05] and oral administration of MLT [p<0.001] significantly reduced MDA levels in red blood cell [RBC] samples compared to the R group. Furthermore, i.p. injection of MLT decreased MDA levels in plasma and tissue [p<0.05]. In the early phase of lung injury, both administration of MLT sig-nificantly increased lymphocyte [p<0.05] and macrophage frequency [p<0.001]. MLT reduced the lung injury index in the lungs compared to the R group [p<0.05]. The result of this study confirms the radioprotective effect of MLT on lipid peroxidation, and in both early and late phases of radiation induced lung injuries in an animal model
ABSTRACT
To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. A case series. Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008. A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software [version 18] was used for the data analysis. In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 [36.87%] cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 [63.13%] patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 [29.1%], Mikulicz procedure in 9 [6.6%], laparotomy detorsion in 37 [27.01%], Hartmann procedure in 47 [34.3%], mesosigmoidoplasty in 3 [2.19%] patients and total colectomy in one [0.73%] case. The overall mortality was 9.8% [22] patients. In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement
ABSTRACT
Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, [lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery], and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score [DS], etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma [in 11 patients] and almost occurred on the left side [in 15 patients]. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4 +/- 7 percent and the average FEV[1] was 52.4 +/- 6 percent and after surgery they were 80.1 +/- 8.6 percent and 74.4 +/- 1 percent respectively. The average increase in FEV[1] and FVC 63.4 +/- 4, 61.1 +/- 7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity
ABSTRACT
Severe pain is a major problem in patients with unresectable pancreatic cancer. The goal of this study is to evaluate the effects of Thoracoscopic Splanchnicectomy [TS] on pain control in these patients suffering from unresectable pancreatic cancer Between years 2000 to 2011, 20 patients suffering from unresectable pancreatic cancer underwent TS due to severe pain. They were studied in terms of age, sex, location of pancreas tumor, history of previous surgery, response to treatments for pain control [assessed with VAS scoring system] and complications of surgery Male to female ratio was 14/6 with a mean age of 63 years. The most common tumor site was at the pancreas head [in 8 patients]. The most cause of unresectability was local expansion to critical adjacent elements [in 10 patients]. Surgery was performed successfully in all patients. Postoperative complication included only pleural effusion on the left side which was cured by proper treatment. There were no post-op mortalities. Fifteen patients had acceptable levels of pain at the end of a six month follow-up period TS provides good pain control, little side effects and minimal invasiveness, the technique is recommended for pain control in patients with unresectable pancreatic cancer
Subject(s)
Humans , Male , Female , Pain , Pancreatic Neoplasms , ThoracoscopyABSTRACT
Regarding the limited number of studies on the feasibility of resection and repair of the small intestine by ligasure, we performed this study to compare ligasure with linear stapler for the previously mentioned operation. This phase 1 clinical trial study was performed in Ghaem Hospital, an educational hospital affiliated to Mashhad University of Medical Sciences, from 2010 to 2011. After obtaining permission from the University's ethics committee and a written informed consent from each patient, we recruited 18 patients. The participants who had morbid obesity and were candidates for laparoscopic gastric bypass surgery were randomly allocated to two stapler and ligasure groups. The data were collected and analyzed by three statistical tests, including Mann-Whitney U test, by SPSS 16. All patients were female with the age range of 20-65 years. Cost in the stapler group ranged between 29,500,000 to 40,000,000 Rial [mean 31,830,000 +/- 3,500,000 Rials] and in ligasure group it was between 24,000,000 to 35,000,000 Rials [mean 26,720,000 +/- 3,290,000 Rials]. There was a significant difference between the two groups in cost [P=0.004]. Duration of the operations were 200 +/- 3.4 and 240 +/- 10 minutes in the stapler and ligasure groups, respectively. The difference in duration was significant between the two groups [P=0.043]. No significant differences were observed in complications. Application of ligasure in resection and reconstruction of small intestine is more cost-effective than stapler, although duration of surgery is longer
Subject(s)
Humans , Female , Aged , Young Adult , Adult , Middle Aged , Surgical Staplers , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/economics , Cost-Benefit AnalysisABSTRACT
Several radiotracers are being used for sentinel node mapping in patients with breast cancer. In the current study, we reported our experience with 99m-Tc Phytate for sentinel node mapping in Mashhad University of Medical Sciences. All breast cancer patients who underwent sentinel node mapping using 99m-Tc Phytate were included. All patients received intradermal peri-areolar injection of 0.5 mCi/0.lcc 99m-Tc Phytate. Lymphoscintiraphy was performed for 145 patients 5-10 minutes post-injection. The sentinel nodes were found during surgery using a hand-held gamma probe as well as blue dye technique. In total 165 patients were evaluated. Lymphoscintigraphy showed axillary sentinel nodes in 135 out of 145 patients [93%] following imaging. At least one sentinel node could be detected in all these 135 patients during surgery. In the remaining 10 patients with sentinel node non-visualization, 5 had sentinel node harvesting failure during surgery. Median number of sentinel nodes on the lymphoscintigraphy images was 1. Sentinel node detection rate was 95% [157/165]. In the 8 patients with sentinel node harvesting failure, 7 had pathologically involved axilla. Median number of harvested sentinel nodes was 1. Mean sentinel node to background count ratio was 10 +/- 2. 99m-Tc Phytate is an effective and highly successful radiotracer for sentinel node mapping. Sentinel node can be visualized in a short time after 99m-Tc Phytate injection on the lymphoscintigraphy images. The sentinel to background count during surgery is high which results in more convenient sentinel node harvesting and high detection rate
ABSTRACT
Complications like chronic diaphragmatic hernia thoracoabdominal stab wound following conservative treatment, make it necessary to find a safe and exact diagnostic method. The aim of this work was to assess, accurate diagnostic value of thoracoscopy in occult diaphragmatic injuries in penetrating thoracoabdominal stab wound. In the present prospective study, from March 2005 to October 2007 at Ghaem, Emam Reza and Shahid Kamyab Hospitals of Mashhad University of Medical Sciences, thirty patients with penetrating thoracoabdominal injuries, with stable hemodynamic and no need to emergent exploration were evaluated. They underwent thoracoscopy to evaluate probable diaphragmatic injuries, which were repaired via thoracoscopy or laparatomy and all patients evaluated for chronic diaphragmatic hernia by CT-scan, 6 months later. Mean age was 26.2 years and M/F ratio was 5:1. In thoracoscopic evaluations five hidden diaphragmatic injuries [16.7%] were observed, that 3 cases [9.9%] were repaired through thoracoscopic approach and laparatomy was inevitable in 2 [6.6%] patients. Lung paranchymal laceration was seen in 2 patients [6.6%], repaired with thoracoscopy and intra abdominal injury was seen in 1 patient [3.3%], repaired with loparatomy. No complication reported after thoracoscopy and there was no evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scan performed 6 months later. In this study, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries was 100%. Because of high diagnostic accuracy rate, and minimal invasively diagnostic and treatment ability of thoracoscopy, this diagnostic method in all clinically stable patients with penetrating thoracoabdominal stab wound is recommended
Subject(s)
Humans , Male , Female , Hernia, Diaphragmatic, Traumatic/diagnosis , Hernia, Diaphragmatic, Traumatic/therapy , Abdominal Injuries/diagnosis , Thoracic Injuries/diagnosis , Tomography, X-Ray Computed , Laparotomy , Lung Injury , Prospective Studies , Wounds, PenetratingABSTRACT
Gasless transanal endoscopic microsurgery of rectum promises to offer a safe and effective option for the selective treatment of patients with rectal lesions. This study describes personal experience of using a modified hand-made device for transanal endoscopic surgery to facilitate surgical access to selected intrarectal lesions with an acceptable cost, safety and effectiveness. This descriptive cross-sectional study carried out from 2003 to 2005 at Ghaem Hospital of Mashhad University of Medical Sciences. This study was approved by the local committee of Medical Ethics. Nine patients including 4 men and 5 women with rectal polyp or tumors with low likelihood of malignancy enrolled in this study. Transanal endoscopic surgery was performed and pathological studies were done on tissue specimens. Data analyzed by SPSS. The location of the mass in the rectum ranged from 5-20 cm from anal verge, and tumors ranged in size from 2 to 7 cm. Mean age of patients was 65 years. Curative local excision performed in 7 of 9 patients [77.8%]. The complications included wound separation [n=1], massive postoperative bleeding [n=1] and temporary incontinence [n=2]. There was no mortality, either recurrence within a follow-up period of 20 months. Mean of operative time recorded 55 minutes. Two patients underwent radical operation later, because of rectal polyposis and involved tomour margin. Transanal endoscopic surgery is a safe and effective option for the selective treatment of rectal lesions. The used device lowered the expenses and simplified the system, using a hand-made special rigid cylinder
Subject(s)
Humans , Male , Female , Microsurgery/methods , Rectum/surgery , Colonoscopy/methods , Anal Canal , Cross-Sectional Studies , Treatment OutcomeABSTRACT
Postoperatively, early enteral feeding has been associated with I-educed protein-store depletion, improved wound healing, and a positive psychological impact, resulting in faster recovery. Thus, early oral feeding after abdominal surgery has been the goal of surgeons for several decades. To evaluate the safety and efficacy of early oral feeding as compared with those placed on a delayed feeding schedule in patients undergoing abdominal hysterectomy. This was a prospective randomized study of 80 women who were undergoing abdominal hysterectomy. They were enrolled in a randomized controlled trial and compared with delayed postoperative oral feeding. Women were divided in two groups. Patients in the early feeding group received oral diet within 6-8 hours of surgery, but those in the control group were given nothing by mouth for 18- 24 hours. They were given clear liquids, and were advanced to solid food on the second or third postoperative day. We reviewed the gastrointestinal outcomes and hospital stays eighty women were studied, with assigned 40 versus 40 to each group. Two groups were similar in age, disease and surgical length. In early-fed patients nausea was more developed [43% versus] 22.4%. p=0.006]. [Despite this, vomiting, abdominal distention, length of post-operative ileus, need of nasogastric tube use was comparable in both groups. Time to development of bowel sound] [1.7 +/- 1.1 days vs 2.2 +/- 1.1 days, p=0.007], time to initiation of solid diet] [1.8 +/- 1.2 days vs. 2.9 +/- 1.4 days, p<0.0001] and hospital stay] [2.3 +/- 1 days vs. 3.9 +/- 1.3 days, p<0.003] were significantly sooner in the early feeding group. Early postoperative feeding in abdominal hysterectomy seems to be safe, well tolerated, and may lead to earlier hospital discharge
ABSTRACT
Background: mucopolysaccharidoses are inherited lysosomal storage diseases that result from the deficiency of specific enzymatic activities and the accumulation of partially degraded acid. Mucopolysaccharidoses lead to distortion of upper airway anatomy with difficult or impossible endotracheal intubation, infiltration of the cervical spine with odontoid hypoplasia placing these patients at risk for atlanto-axial subluxation and quadriparesis, as well as alterations in cardiorespiratory function
Case report: a child with Mucopolysaccharidoses requiring general anesthetic care during umbilical hernia repair, presented; and anesthetic implications of the syndrome are reviewed
Conclusion: general anesthesia and surgical operation can be safe with careful preoperative monitoring and knowledge of the problems
ABSTRACT
Gastroesophageal-vulvar leiomyomatosis is a very rare condition; it is characterized by diffuse, ill-defined proliferation of smooth muscle in the esophagus and vulva. We present an interesting case of esophageal leiomyomatosis in a woman with a history of vulvar leiomyomatosis and a gall bladder full of stones. She was I8-years old and had a 4 year history of vulvar mass and clitoromegaly, with subclinical dysphagia. This paper represents the first reported simultaneous occurrence of these three pathologic entities in the English literature. Esophago-vulvar leiomyomatosis should be considered in a young patient with vulvar mass and long-standing dysphagia in whom a smooth, tapered esophageal narrowing on barium study and circumferential esophageal wall thickening on CT scan are seen. An esophagectomy combined with a reconstruction procedure is indicated