Risk of postoperative hypocalcemia in patients underwent total thyroidectomy, subtotal thyroidectomy and lobectomy surgeries

The main objective of this study was to identify the incidence of post-thyroidectomy hypocalcemia in patients underwent lobectomy, subtotal thyroidectomy or total thyroidectomy. This randomized trial study was performed from May 2010 to July 2011 among 108 consecutive patients undergoing thyroidectomy. Patients were allocated into 3 groups based on the 3 common type of thyroidectomy. Pre and postoperative serum calcium levels were determined by using standard protocol for all patients. All patients' preoperative serum calcium levels were normal. Post-thyroidectomy hypoglycemia occurred in 0%, 8.3% and 8.3% of patients who underwent total hypocalcemia, subtotal thyroidectomy and lobectomy, respectively, which represents 5.6% of all patients who shown hypocalcemia [P=0.58]. Serum calcium levels were fall in 93% patients, however within several days were returned to normal ranges. We did not find a significant relation between the hypocalcemia and thyroidectomy types. We recommended determination other alternative factors as a more effective prediction for postoperative hypocalcemia

Comparison of effects of ephedrine, lidocaine and ketamine with placebo on injection pain, hypotension and bradycardia due to propofol injection: a randomized placebo controlled clinical trial

Propofol is a widely used anesthetic drug because of its minor complication and also its fast effect. One of most popular complication in using this drug is pain during injection that is more sever in new generation of its components [lipid-free microemulsion]. Other complications of propofol are bradycardia and hypotension. This study compares 3 drugs with placebo in control of these complications of propofol. In this double blinded randomized placebo controlled trial 140 patient who were candidates for elective surgery were divided in 4 groups [35 patients in each groups] and drugs [ephedrine, lidocaine, ketamine and NaCl solution [as placebo] were tried on each group by a blinded technician and responses to drugs were evaluated under supervision of a blinded anesthesiologist. Pain after injection, systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP] and heart rate [HR] were measured 5 times during anesthesia process of each patient. All gathered data were analyzed using t-test and Chi-square under SPSS software. Our data shows that in pain management all tested drugs can decrease pain significantly comparing with placebo [P=0.017]. In control of hemodynamic parameters ephedrine could efficiently control SBP, DBP, MAP at the time 1 min after intubation. Based on our study ephedrine can be an appropriate suggestion for control of both pain and hemodynamic changes induced by propofol, although because of inconsistent result in other studies it is recommended to design a systematic review to draw a broader view on this issue.

Laparoscopic versus open appendectomy; which method to choose? a prospective randomized comparison

Appendicitis is the most common surgical emergency with the incidence rate of 6-10%. Although several studies have compared the two approaches of open [OA] and laparoscopic appendectomy [LA] the technique of choice is still a matter of controversy. Considering this background we designed a study to compare OA and LA outcomes in our center. One hundred patients were included in this study performed from April 2008 to April 2009 at Shahid Sadoughi hospital, Yazd, Iran. Patients who gave informed consent were randomized to either OA or LA groups and were operated by McBurney's or laparoscopic technique, respectively. Patients received our center's routine diet, antibiotics and analgesic regimens. The patients' pain was measured by visual analogue scale [VAS] at their entrance to the recovery room and in 6-hour intervals up to 24 hours. Post-operation follow up visits were in weeks 1, 2 and 4. The data of operation time, hospital stay, intra-operation complications, time to resume normal activity, short term complications and neuralgia were collected and analysed. The average operation time was 34.4 +/- 8.42 min in LA and 41.7 +/- 8.84 in OA hand [P=0001]. No intra-operative complication and no LA to OA conversion were encountered in operations. Post-operative complication rate was higher in OA group [n=10] compared to LA [n=3]. The post-operative pain showed less pain in OA only at 6 and 12 hours post-operative times. Patients' mean hospital stay was 52.32 +/- 19.2 and 42.96 +/- 13.8 hours in LA and OA groups, respectively [P=0.003]. Time to resume normal activity didn't show a significant difference between two groups [P=0.53]. Only one case of neuralgia in the OA group was confronted in the follow up visits. LA has less complications and cosmetic scar with the cost of more pain. Decision between OA and LA for each patient should be made individually

Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients

Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography [ERCP] was performed for patients with suspicious to biliary colic and common bile duct [CBD] stones. Ultrasonography, Aspartate Aminotransferases [AST], Alanine Aminotransferases [ALT], Alkaline Phosphatase [ALP] and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter [OR:20; P=0.00] and elevated serum level of ALT [OR:2; P=0.04] were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP

Laparoscopic rectopexy in solitary rectal ulcer

Patients with Solitary Rectal Ulcer Syndrome [SRUS] come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia [63.8%] was significantly higher than cases without that [P=0.04]. Complete recovery rate in cases that had finger defecation [85%] was significantly higher than cases without that [50%] [P=0.03]. Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management