ABSTRACT
BACKGROUND: Appendectomy intra-abdominal is the most frequently performed emergency surgery. This study was conducted to determine the role of postoperative antibiotics in reducing surgical site infections (SSIs) and abscess formation after open appendectomy. METHODS: In the Department of Surgery, Shahid Beheshti Hospital, Babol, Iran, from October 2013 to October 2014 one hundred and fifty two patients, who underwent appendectomy for nonperforated appendicitis (NPA) and fulfilled the selection criteria, were randomized into two groups. Group A patients received a single dose of preoperative antibiotics (ceftriaxone and metronidazole) and group B patients received the same regimen, in addition, antibiotics were administered 24 hours postoperatively. Patients of both groups were followed-up for 30 days to assess the postoperative infectious complications. RESULTS: Both groups comprised 76 patients, as well both groups were compared in baseline characteristics. Statistically, there was no significant difference in rates of SSIs between both groups. None of the patients developed intra-abdominal collection. CONCLUSION: Single dose of preoperative antibiotics (ceftriaxone and metronidazole) was sufficient in reducing SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients.
ABSTRACT
BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most common surgeries in laparoscopic surgery. Although, it is believed that LC has low-risk for post-operative infectious complications, the use of a prophylactic antibiotic is still controversial in elective LC. OBJECTIVE: To determine the impact of prophylactic antibiotics on postoperative infection complications in elective laparoscopic cholecystectomy. METHODS: In this double-blind, placebo-controlled, randomized, clinical trial, patients who were candidates for elective LC, from March 2012 to 2015, in four hospitals in Babol, Iran, were studied. Patients were allocated randomly to two groups, i.e., group C: Cefazolin (n = 182) and group P: placebo (n = 247). Group C received 1 g of Cefazolin 30 minutes before anesthesia and and then, six and 12 hours after anesthesia. Group P patients received 10 ml of isotonic sodium chloride solution. Age, gender, type of gallbladder diseases (stone, polyp, or hydrops), the length of post-operative hospitalization, frequency of gallbladder rupture, the duration of surgery, and the kinds of complications associated with infections were collected for each patient in the two groups. The data were analyzed by IBM-SPSS version 20, using the t-test and the chi-squared test, and a p-value < 0.05 was considered as significant. RESULTS: There were no significant differences between the two groups in terms of gender (C versus P: 18 (9.9%) male versus 22 (9%); p = 0.74), age (C versus P: 43.75 + 13.30 years versus 40.91 + 13.05; p = 0.20), and duration of surgery (C versus P: 34.97 ± 8.25 min versus 34.11 ± 8.39; p = 0.71). There were no significant differences between the two groups in the incidences of post-operative infection (C versus P: 3 (1.7%) versus 5 (2%); p = 0.99) and rupture of the gallbladder (C versus P: 14 (7.8%) versus 17 (6.8%); p = 0.85). No other post-operative systemic infectious complications (e.g., sepsis, pneumonia, or urinary tract infection) were found in either group. CONCLUSION: For patients who underwent laparoscopic cholecystectomy (LC), prophylactic antibiotics had no important role in the prevention of infections; so these antibiotics apparently are not necessary in treatment, and they are not recommended for patients with laparoscopic cholecystectomy as low-risk selective antibiotics. TRIAL REGISTRATION: The trial was registered at the Iranian Clinical Trial Registry (http://www.irct.ir) with the IRCT identification number IRCT2013070413865N1. FUNDING: This research was supported financially by the Research Council of Babol University of Medical Sciences.
ABSTRACT
BACKGROUND: Thalassemia is the most common anemia with hereditary base in Iran. The aim of this study was to evaluate the humoral immune system and assess the effect of splenectomy on the serum level of immunoglobulins IgG, IgM, and IgG and complement components in patients with major thalassemia. METHODS: This quasi-experimental study (before-after) was performed on 40 patients with major thalassemia that referred to the treatment centers of Babol for splenectomy from March 2011 to March 2013. RESULTS: The mean age of patients under study was 25.38±6.89 years. The results of this study showed that the rate of IgA and IgM had a significant decrease after splenectomy. However, the increase of serum level in IgG in this study was not significant. The serum levels of C3 and CH50 were evaluated in all patients that its reduction was statistically significant, but the decrease of serum levels in C4 was not significant. CONCLUSION: The spleen plays a role in releasing immunoglobulins and starter proteins of complement activation pathways and splenectomy causes reduction in the serum levels of immunoglobulins and complement components.
ABSTRACT
BACKGROUND: Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. OBJECTIVES: This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. PATIENTS AND METHODS: In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. RESULTS: In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). CONCLUSIONS: Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care, and the road safety should be noted as problems associated with public health.
ABSTRACT
This case study aims to report an unresolved abdominal mass in an adult with cryptorchid testis and provide a review of related literature. We investigated a 54-year-old man who had cryptorchidism with a history of left orchiectomy 18 years prior. He was diagnosed with an intra-abdominal testicular mass after referring to the emergency ward with pelvic pain. The incidence of testicular cancer in undescended testicles is 40 times greater in the general population. In developed countries, the existence of undescended testicles in adult population is rare, which could be due to systematic practice of elective orchidopexy before the second year of life as well as orchiectomy in post-adolescent patients with undescended testicles. Despite these preventive measures, there are still some isolated cases of intra-abdominal testicular tumors in adults.
