Temporary abdominal closure in the critically ill patients with an open abdomen

The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags [Bogot? bag]. The study population comprised of 11 [57.9%] male and 8 [42.1%] female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 [57.9%] patients, subjective judgment that the fascia closure is too tight in 6 [31.6%] patient's damage control surgery in one patient [5.3%] and development of abdominal compartment surgery in one patient [5.3%]. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 [47.4%] patients, post operative intestinal fistula in 4 [21.1%] patients, post traumatic intra abdominal bleeding in 3 [15.8%] patients and intestinal obstructions in 3 [15.8%] patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 [%21.1] early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 [26.3%] late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 [range 2-54] months. Currently 10 patients [52.6%] are alive at a follow up of 45 [range 1-94] months. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogot? bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage

unusual case of recurrent gastric cancer long after the first gastrectomy due to adenocarcinoma

The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively

Management of sigmoid volvulus: options and prognosis

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

Spontaneous transanal protrusion of ventriculoperitoneal catheter: a case report

Ventriculoperitoneal [VP] shunt placement that diverts the cerebrospinal fluid [CSF] into the peritoneal cavity is the most common method of treatment of hydrocephalus. This shunt has a high incidence of malfunction mainly due to catheter obstruction or infection. About 20% of these complications are abdominal that may occur at any time after shunt placement from 1 week to several years. This study reports a case of 2.5-year old child with a history of hydrocephalus who had a VP shunt placed which was protruded from the anus on the day of referral. The patient was treated successfully after extrusion of the shunt through the anus, receiving antibiotics and being carefully observed. He was discharged from the hospital after one week

Chronic effect of gabapentin on liver function in adult male rats

Gabapentin [GPN] is a new antiepileptic agent currently in used as add-on therapy in adult patients suffering from partial seizures. The extent of liver damage at different dosage and long term treatment with GPN is not yet clear. Therefore this study was undertaken to find out the possibility of liver damage by this drug. Adult male [Wistar] rats of 180-220 g were administered intraperitoneally with GPN [20 or 100 mg/kg] for 45 days. After the experimental period, the liver function tests were carried out in control and experimental groups. The activity of liver enzymes, with 20 mg/kg of GPN were not significantly different from the control group but, the serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, direct bilirubin and total bilirubin were enhanced significantly with 100 mg/kg of GPN. Total protein and albumin decreased in this group as compared with control animals. The histopathology of the liver parenchymal cells also showed minute foci of necrosis in a few rats treated with high dose of GPN, whereas, at therapeutic dose the histopathology and biochemical indices showed almost normal values. At therapeutic dose GPN is a safer drug with regards to liver function and hepatocellular damage as compared with other antiepileptic drugs

[Resection and reconstruction of small intestine with ligasure and linear stapler: a comparative study]

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

[Antibacterial effects of hydro-alcoholic extracts of Ziziphora tenuior, Teucrium polium, Barberis corcorde and Stachys inflate]

Many people are used medicinal plants due to natural, low risks and complications, and low costs as compared with the synthetic drugs. Incidence of drug resistance against chemical antimicrobial drugs has led the use of medicinal plants for treatment of infections in recent years. The aim of this study was to examine possible antibacterial effects of four herbal plants in vitro. Four species of domestic plants from Fars- Fasa [Iran] including Ziziphora, Stachys, Teucrium and Barberry were collected in spring and dried. Hydro-alcoholic extracts of these plants were prepared using standard methods. Antibacterial effects were examined with disk diffusion method and serial both dilution. To standardize of study, we used antibiogram disks and ATCC bacteria. Teucrium extract with 1/8 dilution and Barberry extract with 1/4 dilution showed antibacterial effects in serial dilution method. Moreover, by using the disk diffusion method, antibacterial effects of both mentioned extracts against E.coli ATCC 25922 and S.aureus ATCC 25923, were found as compared amoxicillin, ciprofloxacin, vancomycin and imipenem. The results of this study and other studies show that extracts of herbal plants, instead of chemical drugs, can be used to treat infections. Of course, before using them all their side effects should be carefully checked in vitro and in vivo studies

Sentinel lymph node biopsy in melanoma patients: an experience with Tc-99m antimony sulfide colloid

Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony sulfide colloid in two divided dose was injected around the tumor. All patients underwent surgery 2-4 hours after injection of the tracer. Patent blue V dye was also used for 8 patients. Using a hand-held gamma probe, the sentinel nodes were harvested and sent to the pathologist for frozen section and H and E review. For patients with positive sentinel nodes, lymph node dissection was performed. At least one sentinel node could be harvested in all patients. The mean number of sentinel nodes was 1.66. Detection rate with radiotracer and blue dye was 100% and 75% respectively. 30% of the patients had positive sentinel nodes. One patient in the pediatric age range and one head and neck melanoma were included in our study with successful sentinel node mapping. Sentinel lymph node biopsy using Tc-99m antimony sulfide colloid is a reliable and safe method in melanoma patients which can help in treatment planning and patient's ultimate prognosis

Minimally invasive radio-guided surgery for hyperparathyroidism: an experience with Tc-99m sestamibi

Radio-guided parathyroid surgery along with other minimally invasive surgeries constitutes the main surgical treatment procedures for different kinds of hyperparathyroidism. In this article we have reported our experience of radio-guided parathyroid surgery using Tc-99m sestamibi. Ten patients with hyperparathyroidism included in our study. Twenty mCi of Tc-99m sestamibi was injected intravenously to the patients in the day of surgery. All patients underwent surgery 4 hours after injection of the tracer. Abnormal parathyroid glands were localized by surgical gamma probe during surgery and were removed. Eight out of 10 patients had single adenoma. One patient had parathyroid hyperplasia secondary to chronic renal failure. The one remaining patient had persistent hyperparathyroidism with previous unsuccessful parathyroid surgeries. Except for the patient with parathyroid hyperplasia, parathyroid hormone [PTH] level of all other patients decreased after surgery including the patient with persistent hyperparathyroidism. Minimally invasive radio-guided parathyroid surgery is an easy and safe method for surgical treatment of hyperparathyroidism. With the increasing availability of surgical gamma probes and nuclear medicine facilities in Iran considering this kind of approach for surgical treatment of hyperparathyroidism seems rational

[Traumatic obstruction of duodenum [report of 2 cases]]

Duodenal hematoma occurs rarely due to blunt or penetrating trauma and it may cause intestinal obstruction. Half of the patients with duodenal hematoma show symptoms of obstruction 48 hours after trauma. After ruling out other visceral injuries, treatment is essentially conservative and laparoscopic or surgical drainage is rarely necessary. First case was a 16-year-old man who referred to the hospital with abdominal pain, vomiting and tenderness of upper abdominal quadrant, 2 days after blunt abdominal trauma. Diagnosis was made with CT scan and upper GI radiography. After 10 days of conservative treatment, patient was discharged from hospital in a good condition. The second case was a 25-year-old man who referred to the hospital 3 days after blunt abdominal trauma. Patient symptoms were; vomiting, pain and tenderness in upper abdominal regions. Diagnosis was made with ultrasonography, CT scan and upper GI contrast radiography. After 6 days of conservative therapy he tolerated oral diet and was discharged from hospital with good condition. Trauma is not a common cause of alimentary tract occlusion. If obstructive symptoms appear after trauma, the hematoma of intestine particularly duodenum must be considered. The protocol for conservative therapy of hematoma includes: 1] Early diagnosis and ruling out any duodenal leakage through upper GI radiography at admission and 5-7 days later, 2] On time diagnosis of associated injuries like pancreatic injuries, 3] Parenteral nutrition and intravenous hyperalimentation if needed