Evaluation of the Safe Ischemic Time of Clamping During Intermittent Pringles Maneuver in Rabbits.

BACKGROUND: The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle's maneuver), continuous prolonged clamping results in liver ischemia. OBJECTIVES: The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models. MATERIALS AND METHODS: In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers. RESULTS: There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation. CONCLUSIONS: Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.

Pediatric elbow fractures in a major trauma center in iran.

BACKGROUND: Elbow fractures are one of the most common traumatic fractures in the pediatric population. Since severe complications may occur, appropriate diagnosis and treatment are imperative when dealing with this type of fracture. OBJECTIVES: The aim of this study was to evaluate the epidemiology of elbow fracture in children admitted in Alzahra hospital, Isfahan, IR Iran over a one year period. PATIENTS AND METHODS: During a one year period, a prospective study was conducted on 300 patients under the age of 16 who had sustained elbow fractures. Data included age, gender, mechanism of trauma, type of elbow fractures, complications, and outcomes. RESULTS: The mean age of the patients was 8.1 ± 2.31 years old. Boys were injured 2.6 times more often than the girls. Falling was the major cause of pediatric elbow fractures (86%). Supra condylar were the most common type of fracture. There was a significant association between gender and type of injury (P < 0.01). CONCLUSIONS: Supracondylar fracture is the most common fracture type resulting from 4 - 8 year old boys' falls. Our findings indicate the critical nature of appropriate treatment in order to prevent severe complications.

Vest-over-Pant Method for Closure of Residual Cavity of Liver Hydatid Cyst.

Objective. Although several therapeutic strategies have proven to be effective for hydatid cyst of liver, but surgery is still the most common therapy despite its morbidity and mortality. Furthermore, a variety of technique has been recommended for managing the residual cavity after cystectomy. We report here a new technical method for the reconstruction of hydatid cyst residual cavity with using overlapping flaps of liver edges (Vest over Pant). Methods. In this technique after removing the cyst, the edges of one side of cyst cavity were sutured to the base of the cavity using three to four mattress sutures), and edges of other side of liver was overlapped on the dorsal part of previous layer using four to five mattress sutures. Therefore residual cavity dead space was obliterated with two surfaces of cavity. Results. Fifty males were treated by our method. The average cyst volume was 423 ± 110 mL. There was no intraabdominal sepsis, bile leakage, or hepatic necrosis. In follow-up ultrasound study, residual cavities were disappeared one month after operation. Conclusion. Overlapping flaps of liver edges (Vest over Pant) provides easy, safe closure of cyst with preservation of the liver anatomy.

Preemptive use of ketamine on post operative pain of appendectomy.

BACKGROUND: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. METHODS: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). RESULTS: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 ± 6.7 minutes for the case group and 18.1 ± 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 ± 0.6 for the case group and 2.0 ± 0.8 for the controls (P = 0.032). There were no drug side effects for the case group. CONCLUSIONS: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

Methylene blue usage in the evaluation of traumatic necrosis in a rabbit liver injury model.

BACKGROUND: In this study, the efficacy of methylene blue in the differentiation of devascularized and vital areas in a traumatic liver model in rabbits was investigated. METHODS: Twenty healthy rabbits were selected and randomly divided into two equal groups. Surgery was performed through an upper abdominal mid-line incision 5 cm in length. After induction of liver injury, diluted methylene blue was injected through the portal vein and staining onset and discoloration times were recorded. RESULTS: All 20 rabbits survived until the end of the experiment. In cases, non-perfused areas of the liver remained unstained. In control rabbits, liver parenchyma was stained homogeneously. The mean onset time of staining in normal parenchyma was 18.1+/-1.3 sec in cases and 17.7+/-1.4 sec in controls (p=NS). The mean discoloration time was 53.1+/-3.7 sec in cases and 53.1+/-3.2 sec in controls (p=NS). CONCLUSION: In major liver injuries requiring surgical intervention, methylene blue injection can be used for detection of non-perfused areas in the liver.

Evaluation of small bowel measurement in alive patients.

INTRODUCTION: Based on the importance of bowel length in massive bowel resection, the aim of this study is to evaluate the small bowel length in patients who had laparotomy. METHODS: In this study, 100 consecutive adults (age >/= 20 years old) who underwent laparotomy were studied. Patients with peritonitis, intra-abdominal infection, bowel obstruction and ascitis were excluded. For comparison we used 30 cadavers as control group after case control matching. Under general anesthesia and after opening of abdomen, bowel length was measured by an umbilical tape from Treitz' ligament to ileocecal valve, antimesentrically. Data such as age, sex, height, weight and bowel length were measured and analyzed. RESULTS: Between May 2007 and December 2007, 100 patients (54 males and 46 females) aged 20-43 years were studied. The small bowel length was 459.6 +/- 78.47 cm in patients and 632.5 +/- 88.9 cm in cadavers (P < 0.01). Small bowel length was 452.2 +/- 79.36 cm in males and 468.2 +/- 80.44 cm in females (P = NS). Jejunum length was 140.2 +/- 45.4 cm in males and 138.6 +/- 40.2 cm in females (P = NS). Ileum length was 286.3 +/- 34.7 cm in males and 289.9 +/- 37.8 cm in females (P = NS). CONCLUSION: In this study, we report a measurement of the length of small bowel more accurate than the estimation given by the classical anatomic books. In our study, there was no correlation between bowel length and age, gender, height and weight.