Comparison of the Effect of Massage and EMLA Cream on Children's Physiological Indices During Venipuncture: A Factorial Clinical Trial.

PURPOSE: The aim of this study was to identify the effect of massage, EMLA cream, and the combination of these two methods on changes in physiological indices because of pain caused by intravenous line insertion in preschool children. DESIGN: A four-group randomized nonblinded clinical trial with factorial design. METHODS: In total, 140 eligible 3- to 6-year-old children entered the study in Tabriz Children's Hospital in 2017 and were randomly allocated to four groups (EMLA cream, massage, combination of the two, and control). Physiological responses were measured before and immediately after interventions in all groups. Data were collected and analyzed using SPSS version 19. FINDINGS: Comparison of the physiological indices changes caused by pain between groups showed that changes in children's heart rate (HR) and respiratory rate (RR) in the EMLA group and in the combined-method group were statistically significant (P < .05). No significant differences were found in systolic blood pressure and oxygen saturation (SPo2) between the four groups. CONCLUSIONS: Results indicated that EMLA cream was more effective than massage and a combination of EMLA and massage in reducing an increase in the HR and RR caused by pain in children. Massage alone was not effective in significantly lowering the children's increased physiological indices such as the HR and RR, and it seems the effectiveness of massage is more noticeable in conjunction with EMLA cream.

Abu Al-Qasim Al-Zahrawi (936-1013 CE), Icon of Medieval Surgery.

Abu al-Qasim Al-Zahrawi (936-1013 common era [CE]), also known in the West as Albucasis, was a great Arab physician and surgeon of the late 10th and early 11th centuries CE. He is best known for his surgical knowledge and expertise. His greatest contribution to medicine is the Kitab al-Tasrif, which includes thirty treatises on medical sciences. His early and great contributions to the field of surgery were seminal. For his endeavors in this field, a number of surgeons and scholars have dubbed him the "Father of Operative Surgery".

Accuracy of ultrasonography in detecting gastrointestinal tract obstructions in children; a prospective study in a tertiary referral hospital.

AIMS: To examine the diagnostic accuracy of plain radiography, abdominal ultrasonography (US), and their combination in pediatric patients with suspected gastrointestinal (GI) tract obstruction. MATERIAL AND METHODS: A cohort of 48 patients (age, 0-14 years, 27 boys) with clinical manifestations of GI tract obstruction underwent plain radiography and abdominal US examination. The final diagnoses were based on intraoperative findings, rectal biopsies (in Hirschsprung's disease), or adequate follow-ups. RESULTS: The GI tract obstruction was diagnosed in 40 patients. The sensitivity, specificity, positive predictive value and negative predictive value of plain radiography in diagnosing GI tract obstruction were 87.5%, 75.0%, 94.6%, and 54.6%, respectively. The corresponding values were 95%, 100%, 100%, and 80%, respectively when US was used alone; and 97.5%, 100%, 100% and 88.9%, respectively when radiography and US were used together. Except for two patients (one with Hirschsprung's disease and the other with massive peritonitis), US detected the underlying causes of obstruction correctly in all patients. CONCLUSIONS: US is a highly sensitive and specific modality in diagnosing pediatric GI tract obstructions, as well as their causes. The combination of plain radiography and US further increase the diagnostic sensitivity and negative predictive value.

Different clinical presentations of choledochal cyst among infants and older children: A 10-year retrospective study.

Choledochal cyst is a rare and often benign congenital cystic dilation throughout the biliary tree. Due to the benign nature of choledochal cyst among early-diagnosed patients, the clinical assumption and diagnosis seem to be of utmost significance. Therefore, we sought to assess different clinical manifestations of choledochal cyst and relevant laboratory findings in infants and older children.Retrospectively, medical records of all patients with the diagnosis of choledochal cyst between 2005 and 2015 were reviewed. Demographic data, initial clinical presentation, positive findings on physical examination, history of any remarkable behavior such as persistent and unexplained crying and poor feeding, and diagnostic imaging modalities were listed. In addition, laboratory values for total and direct bilirubin, alkaline phosphatase, alanine transaminase, aspartate transaminase, prothrombin time, and partial thromboplastin time (PTT) were recorded for each patient. Patients were divided into 2 groups; younger than 1-year-old (infants), and 1 year to 18 years old (older children). Demographic data, clinical data, and laboratory values were compared between the infants and older children.Thirty-two patients with a diagnosis of choledochal cyst were included in the study: 9 patients (28.12%) were infants and 23 patients (71.87%) were older children. Abdominal pain was the most common presenting symptom (62.5%), followed by nausea/vomiting (59.4%) and jaundice (28.1%). None of the patients presented with the classic triad of abdominal pain, jaundice, and right upper quadrant mass. Seventeen older children (73.91%) presented with nausea and vomiting, while 2 subjects (22.22%) in the infantile group presented with this feature (P = .01). Similarly, abdominal pain was found in 20 older children (86.95%); however, none of the infants presented with abdominal pain at diagnosis (P < .001). By contrast, the abdominal mass was more detected in infants than the older children (33.33% vs. 0%, P = .01). In terms of laboratory values, the median PTT was 44 and 36 s in infants and older children, respectively (P = .04).Infants were more likely to present with abdominal mass and older children were more likely to have nausea, vomiting, and abdominal pain. Furthermore, infants had more prolonged PTT than older children, implying a potential bleeding tendency.

Is there any correlation between radiologic findings and eradication of symptoms after pyloromyotomy in hypertrophic pyloric stenosis?

BACKGROUND: Hypertrophic pyloric stenosis (HPS) is one of the most common gastrointestinal disorders during early infancy, with an incidence of 1-2:1000 live births in the world. In this study, we aimed to investigate the correlation between radiologic findings and eradication of symptoms after pyloromyotomy in HPS. MATERIALS AND METHODS: One hundred and twenty-five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between March 21, 2004 and March 20, 2014 at paediatric surgery ward of Tabriz Children's Hospital, Iran. The demographic features, clinical findings, diagnostic work-up, operation type and postoperative specifications of the patients were studied retrospectively. RESULTS: Male to female ratio was 4:1. The patients were 16-90 days of old and the mean age was 39 ± 1.42 days. The range of pyloric canal length was 7.60-29.00 mm and the mean length was 19.54 ± 3.42 mm. Pyloric muscle diameter was 2.70-9.00 mm, and the mean diameter was 4.86 ± 1.14 mm. Seventy-two percent of patients had episodes of vomiting after operation. Mean time of persistence of vomiting after pyloromyotomy was 15.73 ± 0.15 h. Mean discharge time was 55.22 ± 0.08 h. Radiologic findings did not show any significant correlation with persistence of vomiting or discharge time. CONCLUSION: The present study revealed that radiographic findings could not predict postoperative symptom eradication after pyloromyotomy in HPS.

A rare case of aphallia with right kidney hypoplasia and left kidney dysplasia.

Aphallia or penile agenesis is an extremely rare congenital anomaly with an estimated incidence rate of 1 in 10 to 30 million births. We report a rare case of aphallia with right kidney hypoplasia and left kidney dysplasia in a 10-day old Iranian-Azeri male. The patient had creatinine rise and renal failure due to dysplastic left kidney and hypoplastic right kidney and expired on fifth day of admission. There were only six cases of renal malformation associated with aphallia in the literature review. Three of the cases were complicated by Potter sequence and one of them was accompanied by chronic renal failure. Our case had a unique presentation because of bilateral renal malformation and subsequent renal failure without the Potter sequence.

DR. SAKINEH PARI, THE FIRST IRANIAN FEMALE SURGEON.

Modern surgery has been evolved in Iran by the establishment of Dar al-Funun and Tehran University in 1851 and 1934 respectively. Professor Yahya Adl established the first academic department of surgery at Tehran University in 1930s and he is known as the father of modern surgery in Iran. Until recent times, women's options for obtaining advanced surgical training programs were severely restricted all over the world. Dr. Sakineh Pari, born in 1902, was the first Iranian female surgeon. The aim of this article is to introduce Dr. Sakineh Pari as the first woman surgeon in Iran.

Tumour necrosis factor-alpha gene polymorphisms in Iranian patients with biliary atresia.

BACKGROUND: Biliary atresia (BA) is a progressive inflammatory destructive process of the bile ducts. This study evaluated the relationship between single-nucleotide polymorphisms in the promoter region of tumour necrosis factor-alpha (TNF-α) gene and bilaiary atresia. MATERIALS AND METHODS: Genomic deoxyribonucleic acid from 16 patients with established diagnosis of BA and 36 patients with INC was obtained. The genotypes of TNF-α-1031 (T/C) and TNF-α-308 (G/A) were determined using the restriction fragment length polymorphism-polymerase chain reaction and the results were analysis with proper statistic software. RESULTS: The frequencies of T/T, T/C in TNF-α-1031 and G/G, G/A in TNF-α-308 were as same as control group. Moreover, we have same deduction for allele frequency and haplotypes analysis (T allele: 84.37%; G allele: 87.5%) in BA patients (T allele: 80.56%; G allele: 86.11%) in controls. In all cases variants of polymorphism did not affect the severity or incidence of BA disease. CONCLUSION: although no significant associations were found between BA and control groups, it seems meaningful that since the nature of BA is multi factorial. Next step will be considering a new target such as downstream modulation of the TNF-α pathway or other cytokines and chemokines which act directly/indirectly.

The effect of quince leaf (Cydonia oblonga miller) decoction on testes in hypercholesterolemic rabbits: a pilot study.

Current medical literature lacks any evidence of the protective effects of quince leaf on testes. Therefore, the aim of the present study was to assess the effect of quince (Cydonia oblonga Miller) leaf decoction on testicular injury and impaired spermatogenesis induced by hypercholesterolemia in rabbits. Eleven mature New Zealand white male rabbits were randomly divided into three groups: group 1 (hypercholesterolemia, n=3), group 2 (hypercholesterolemia plus quince treatment, n=6), and group 3 (control, n=2). Groups 1 and 2 received a cholesterol-enriched diet for six weeks. Group 2 received C. oblonga leaf decoction as drinking supplement as well. After six weeks, a normal diet was substituted in groups 1 and 2 for another six weeks. Group 3 (control group) was maintained throughout the study on a regular diet. At the end of the 12(th) week, the left testes of the animals were resected for light microscopic study with particular attention to the maturity of germ cells in seminiferous tubules using Johnsen's score. Increase in intertubular connective tissue and diameter of vessels, abundant spermatogonia and primary spermatocytes along the reduced germinal epithelium were noted in all rabbits of the group 1. The remaining animals in groups 2 and 3 had no significant changes in their testicular sections. The mean Johnsen's score of group 1 (4.20 ± 1.92) was significantly lower than that of group 2 (7.33 ± 0.52) and group 3 (7.05 ± 0.07). (P=0.01). In conclusion, quince leaf decoction (C. oblonga Miller) protected rabbit testes and spermatogenesis from damage induced by hypercholesterolemia.

Hydatid cyst in children: A 10-year experience from Iran.

BACKGROUND: Hydatid disease is one of the major world-wide health problems especially in endemic countries. Due to lack of statistics about this disease, various aspects of hydatidosis in children in North-West of Iran have been studied in this study. MATERIALS AND METHODS: We studied 59 children with hydatidosis referring Tabriz Children Hospital, Tabriz, Iran from 2001 up to 2011. We surveyed chief complaint of patients, number, size and location of cysts in children and also we studied cysts as if they are infected or ruptured or not. RESULTS: Average age of 59 patients (32 [54.2%] males and 27 [45.8%] females) was 7.93 ± 3.0. The most common chief complaints were cough and pain. Number of cysts was higher in females (2.00 ± 2.8 vs. 1.52 ± 1.0). The most common locations of cysts are lung and liver (52 patients); however, other organs had been also affected. CONCLUSIONS: Lung hydatidosis is more common than hepatic hydatidosis in children than adults and it is more frequent in males. Hydatid disease should be considered in differential diagnoses of liver and lung cystic lesions in children.

Acute and chronic pathological effects of sulfur mustard on genitourinary system and male fertility.

PURPOSE: To review the acute and chronic pathological effects of sulfur mustard on the genitourinary system and male fertility. MATERIALS AND METHODS: We searched PubMed and Google Scholar to find studies related to the sulfur mustard-induced genitourinary effects and male infertility. Information in the abstracts of non-English related papers as well as those in the proceedings of congresses on sulfur mustard were reviewed as well. RESULTS: In acute phase after sulfur mustard exposure, evidences are in favor of microscopic and macroscopic renal lesions, very low androgen levels, and impaired spermatogenesis. Several years following sulfur mustard exposure, the long-term pathological effects vary from the renal function impairment to the gonadal damage, in particular the spermatogenesis. Nevertheless, carcinogenic effect of sulfur mustard on the genitourinary system as well as the prevalence of male infertility among sulfur mustard-exposed veterans in the chronic post-exposure phase is still unclear. CONCLUSION: Sulfur mustard causes both acute and chronic injuries to different parts of the genitourinary system.

Contributions of Medieval Islamic physicians to the history of tracheostomy.

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions.