Evaluation of clinical complications in morbid obese patients after modified jejunoileal bypass surgery

Background and Objective: Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications. This study was carried out to assess the evaluation of clinical complications in morbid obese patients after modified jejunoileal bypass surgery. Method: This descriptive – analytic study was carried out on 120 morbid obese patients referred for bariatric surgery. A modified jejunoileal bypass was performed in which the defunctionalized organ eliminated by anastomosing its ends to the gall bladder and cecum. Weight loss and clinical complications were recorded after one year follow up. Results: The mean weight and body mass index reduced from 136 kg and 48 kg/m2 before surgery to 83 kg and 29/8 kg/m2 after one year follow up, respectively [P<0.05]. Before surgery, articular pain [24.3%], dispana [21.6%], cardiovascular disorders [10.8%], fatty liver [5.4%] and sleep disorder [5.4%] due to obesity were recorded. One year follow up after surgery, articular pain [1.5%] and dispana [1.5%] were seen in patiants. No serious post-operative clinical complication was observed. Conclusion: One year follow up after surgery showed that the modified jejunoileal bypass is very effective in reducing body weight and does not lead to serious complication

[Evaluation of the role of hyperbilirubinemia in the diagnosis of complicated appendicitis]

Early and precise diagnosis of complicated appendicitis [gangrene, perforation, …] and proper surgical measures are necessary to prevent mortality and morbidity. The aim of this study was to investigate the diagnostic value of serum bilirubin level as a preoperative laboratory marker in the diagnosis of complicated appendicitis. We evaluated 295 patients with primary diagnosis of acute appendicitis in Shahid Rajaee Hospital in Qazvin City. Demographic information, pain duration and other clinical findings such as fever and history of liver disease and the findings of physical examination were recorded in a predefined questionnaire. Then CBC diff. and serum total bilirubin of the patients were checked and macroscopic findings of appendix in the operating room and final pathologic diagnosis were also entered on the questionnaire. Appendicitis was more frequent in the patients between 15 and 20 years of age [42.7% of the patients]. The mean age of patients was 30.35 years old, 60% were male and 40% female. Leukocytosis and shift to the left were detected in 98.5% of the patients with complicated appendicitis and 85.6% of the cases without any complications which showed a significant difference [P<0.001]. The serum bilirubin level was significantly higher in the patients with complicated appendicitis [P<0.01]. This study showed that patients with clinical symptoms of appendicitis and hyperbilirubinemia were more likely to develop complications in comparison to the patients with normal bilirubin level. Therefore, measurement of serum bilirubin level together with WBC count can be helpful for assessment and diagnosis of complicated appendicitis

[New method for treatment of intrabony vascular malformation of the mandible]

Vascular malformations are presented at birth. Some %35 of vascular malformations occurs in bone. Intrabony hemangioma may also occur and probably is indicative of either venous or arteriovenous malformations. The aim of this report was to assess previous studies and also presenting a patient with intrabony vascular malformation. A twenty - year old man with an extensive multi-locular radiolucent lesion at the right side of mandible with bone destruction, buccal and lingual cortex expansion, malocclusion, teeth displacement, facial asymmetry, and bleeding after tooth extraction or biopsy was referred for control of bleeding. Intra - osseous hemangioma was diagnosed by clinical and para - clinical [panoramic - computerized tomography - angiography] examinations. Following access to external carotid artery by a vascular surgeon and retraction of buccal and lingual soft tissues, the right side of mandible was resected [from middle portion of ramus to left central incisor]. After complete curettage of lesion and inter - maxillary fixation, the mandibular bone was fixed at its exact location by using three plates and ten screws for six weeks. The advantages of this method are: The use of patient's bone for mandibular reconstruction bypasses the process of bone harvesting from another site [iliac - calvarium], Shorter time of surgery and general anesthesia and lower morbidity rate, Intra - orally approach leaves no scar on the skin

[Lateral esophagostomy with thoracic drainage in treatment of esophageal perforation]

Esophageal perforation is a true emergency caused by instrumentation, spontaneous rupture known as Boerhaave syndrome, foreign bodies, and trauma. For patients with an early diagnosis [less than 24 hours], the primary repair is performed and in case of delayed diagnosis the end esophagostomy with thoracic drainage and tube jujunostomy is the treatment of choice. The aim of this study was to evaluate the surgical technique of lateral esophagostomy with thoracic drainage in treatment of esophageal perforation. This cross-sectional study was performed based on information derived from three patients admitted to the emergency ward of Shahid Rajaei hospital in Qazvin with the diagnosis of esophageal perforation who underwent lateral esophagostomy with thoracic drainage and tube jujunostomy. Three patients with esophageal perforation caused by foreign bodies or Boerhaave syndrome underwent surgery with lateral esophagostomy, thoracic drainage, and tube jujunostomy technique. Following surgery, the patients were transferred to ICU and all recovered. This study confirms that patients with esophageal perforation, who undergo lateral esophagostomy, thoracic drainage, and tube jujunostomy, make a good recovery soon after a simple and short duration surgery without invasive surgical procedure

[Case report Surgical treatment of choledochal cyst]

Choledochal cysts are congenital cystic dilatation of the extrahepatic and / or intrahepatic billiary tree. Treatment of choice is surgery which varies according to the type of choledochal cysts. The present case was a woman with abdominal pain, jaundice, nausea, vomiting and pruritus, underwent surgery at Shahid Rajai Hospital in Qazvin. Intraoperative finding was choledochal cyst [Type V]. The extrahepatic cysts were excised and Roux- en-y hepaticojejunostomy, end to side jejunojejunostomy and cholecystectomy was performed which was accompanying with a good response

Pattern of congenital dislocation of the hip [CDH] in Iran: a preliminary report on 2686 newborn

To find out the pattern of CDH in Iran 2,686 new born babies were examined. There were 30 hips dislocated in 18 babies, therefore the incidence of CDH in Iran is about 6 per 1,000