An experimental rat model of hilar splenic vessel ligation versus splenectomy for spleen trauma.

BACKGROUND: The most prevalent method of treating splenic injury is by splenectomy. This method is followed by postoperative complications. Therefore, less invasive procedures such as splenic angioembolization are introduced. This technique needs appropriate training, a high-tech setting and could be followed by complications. Thus, not all surgeons agree to do this procedure. Splenic hilar ligation of main vessels is a non-invasive procedure which has similarities to a splenectomy with unknown results. OBJECTIVES: We aim to evaluate and compare splenectomy and hilar ligation. METHODS: Thirty rats were divided into splenectomy and splenic hilar ligation groups. An identical grade 3-spleen injury was performed on all rats. After 6 weeks blood samples were obtained and hematologic and immunologic aspects were measured in their serum. Giemsa stained peripheral blood smears were obtained from the ligation group. RESULTS: Comparing the above-mentioned variables before and after the surgery in each groups showed statistical significance in all aspects except IgM, C4 and platelets levels in ligation group (P value: 0.213, 0.059 and 0.649 respectively). Analysis revealed significant deference in postoperative WBC, IgM and C4 levels between splenectomy and ligation group (P value: < 0.001, < 0.001 and 0.026 respectively). CONCLUSION: Splenic hilar ligation of main vessels is an easy way of treating splenic injury in hemodynamically stable patients with less postoperative complications. Therefore, it can be performed by all surgeons in all kind of medical centers. Spleen remains viable and continues its role although some aspects of its function become interrupted.

Effects of Topical Tamoxifen on Wound Healing of Burned Skin in Rats.

BACKGROUND: This study aimed to assess the effects of the topical application of tamoxifen on wound healing of burned skin in Wistar rats by evaluating 3 healing characteristics: fibrotic tissue thickness (FTT), scar surface area (SSA), and angiogenesis in the healed scar tissue. METHODS: Eighteen male Wistar rats were used in this study. A third-degree burn wound was made on the shaved animals' back, measuring 2×2×2 cm. In the first group, a 2% tamoxifen ointment was applied to the wound twice daily for 8 weeks. The second group received a placebo ointment during the same period. The third group did not receive any treatment and served as the control group. RESULTS: The median (interquartile range=[Q1, Q3]) FTT was 1.35 (1.15, 1.62) mm, 1.00 (0.95, 1.02) mm, and 1.25 (0.8, 1.5) mm in the control, tamoxifen, and placebo groups, respectively (P=0.069). However, the FTT in the tamoxifen group was less than in the placebo and control groups. The median angiogenesis was 3.5 (3.00, 6.25), 8.00 (6.75, 9.25), and 7.00 (5.50, 8.25) vessels per high-power field for the control, tamoxifen, and placebo groups, respectively (P=0.067). However, the median angiogenesis was higher in the tamoxifen group than in the control group. No significant difference was observed in the mean SSA between the tamoxifen group and the control group (P=0.990). CONCLUSIONS: Local application of tamoxifen increased angiogenesis and decreased the FTT, with no change in the SSA in burned skin areas. These effects are expected to expedite the wound healing process, reducing contracture and preventing hypertrophic scar and keloid formation.

Obstructed Defecation Syndrome After Delivery Trauma.

BACKGROUND: Obstructed defecation syndrome (ODS) occurs in about 7% of adults; it seems that the etiology of pelvic floor disorders is multifactorial. Pregnancy and childbirth damage to the pelvic nerve and muscles are proposed causes for this condition. The precise role of vaginal delivery (VD) is not clearly defined, although in recent studies association of pelvic floor disorder with Operative vaginal delivery and episiotomy has been proposed. OBJECTIVES: In this prospective study, we assessed the outcome of stapled transanal rectal resection (STARR) in females with one of the two modes of delivery (VD or caesarean section (C/S). PATIENTS AND METHODS: We used Longo's ODS score for the assessment of the severity of pelvic floor malfunction. Stapled Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. Follow-up was done 12 months after the discharge. To assess the role of episiotomy in patient with VD, we divided them into two subgroups; females who had VD with episiotomy (Vd + epi) and females who had VD alone. Data were analyzed using SPSS version 20 software. P values less than 0.05 were considered statistically significant. RESULTS: In 30 consecutive females undergoing STARR for the treatment of ODS, who enrolled in this prospective study, 19 (63.3%) had Vaginal Delivery VD and 11 (36.7%) had Cesarean Section (C/S). The ODS score before the surgery was higher in females who had C/S, although there was no significant difference between VD and C/S groups in terms of the percentage of the ODS score improvement after the STARR surgery. CONCLUSIONS: Higher ODS score in females who had C/S showed that C/S could not protect the pelvic organ from pregnancy and delivery trauma. It seems that episiotomy has a protective effect during VD; it can reduce the severity of trauma in pelvic organs during childbearing.

Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy.

OBJECTIVE: To determine the risk of postthyroidectomy hypocalcaemia by measuring parathyroid hormone (PTH) level after thyroidectomy. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Baqiyatallah Hospital, Tehran, Iran, from March 2008 to July 2010. METHODOLOGY: All included patients were referred for total or near bilateral thyroidectomy. Serum Calcium (Ca) and PTH levels were measured before and 24 hours after surgery. In low Ca cases or development of hypocalcaemia symptoms, daily monitoring of Ca levels were continued. Data were analyzed using SPSS 20 software (SPSS, Chicago, IL, USA). A p-value less than 0.05 were considered statistically significant. To assess the standard value of useful predictive factors, we used receiver operating characteristic (ROC) curves. RESULTS: Of total 99 patients who underwent bilateral thyroidectomy, 47 patients (47.5%) developed hypocalcaemia, out of them, 12 (25.5%) became symptomatic while 2 patients developed permanent hypoparathyroidism. After surgery, mean rank of PTH level within the normocalcaemic and hypocalcaemic patients was 55.34 and 44.1 respectively, p=0.052. Twenty four hours after surgery, 62% drop in PTH was associated with 83.3% of symptomatic hypocalcaemic. For diagnosis of symptomatic hypocalcaemia, 62% PTH drop had sensitivity and specificity were 83.3% and 90.80%. The area under the ROC curve for the PTH postoperative and PTH drop for diagnostic symptomatic hypocalcaemia were 0.835 and 0.873 respectively. CONCLUSION: Measuring PTH levels after 24 hours postthyroidectomy is not reliable factor for predicting hypocalcaemia itself. For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia.

Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection.

BACKGROUND: The tendency towards sphincter preserving for low rectal cancers with low anterior resection, has led to the technique of straight coloanal anastomosis (SCAA) or colonic J-pouch anal anastomosis (CPAA). OBJECTIVES: The aim of our study was to compare functional outcomes, complication rates and quality of life (QoL) after LAR with either a straight or colonic J pouch anastomosis. PATIENTS AND METHODS: In 88 patients with rectal tumors located in lower third, who were candidate for LAR with coloanal anastomosis. They were divided for reconstruction using either SCAA (n= 47) or CPAA (n= 41) from January 2007 to May 2009. Functional results were assessed after closure of temporary loop ileostomy, 6 months postoperatively. Quality of life (QoL) was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. RESULTS: The two groups were matched for gender, age, and preoperative chemotherapy and radiotherapy. There were no significant differences between the SCAA and CPAA groups relative to anastomotic leakage. Among patients with CPAA, the mean of 24 hours bowel movements, daytime bowel movements, incontinence scores, and incidence of urgency were significantly lower than those in the SCAA group. Also, patients with a CPAA had a significantly better quality of life. CONCLUSIONS: CPAA provided not only better functional results than SCAA, but also improved quality of life, thus may be the better choice.

Laparoscopic cholecystectomy versus small incision cholecystectomy in symptomatic gallstones disease.

OBJECTIVE: To compare the results and outcomes of the laparoscopic cholecystectomy (LC) with the small incision cholecystectomy (SIC). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Baqiyatallah Hospital, Tehran, Iran, from February 2008 to March 2009. METHODOLOGY: Patients with symptomatic gallstones that were referred and enrolled in the study for LC or SIC. Operation, anaesthesia, analgesics and postoperative care were standardized. The patients were assessed for operation time, postoperative pain, nausea, vomiting, hospital stay, return to work time and complications in the postoperative period on day 1, 1 week, 1 month and 6 months, postoperatively. RESULTS: Of 144 patients, 81 underwent LC and 63 underwent SIC. Both groups were matched for age, gender, BMI, clinical findings and ASA grading. The mean duration of operation was 74 and 62 minutes in the LC and SIC groups, respectively (p = 0.0059). Duration of hospital stay and return to regular activities were shorter after LC compared to SIC. Pain scores, nausea and vomiting were the same in both groups, although the frequency of intra-operative complications were greater in LC compared to SIC. CONCLUSION: Outcome and complications of SIC were comparable with those of LC.

Milligan-Morgan Hemorrhoidectomy vs Stapled Hemorrhoidopexy.

BACKGROUND: The stapled hemorrhoidopexy (SH) is a procedure for prolapse and hemorrhoids . At first SH seemed to be a good alternative for the Milligan Morgan (MM) hemorrhoidectomy and preliminary results in early 2000 confirmed it. However, further studies and evaluation of long-term results showed poorer outcomes. OBJECTIVES: This study aimed to evaluate and compare the results of these 2 surgical procedures in terms of recovery, improvement of symptoms and incidence of complications. MATERIALS AND METHODS: This study was conducted from April 2008 to August 2010. A total of 80 patients were divided into 2 groups of 40 each. In the SH group, there were 24 males (60%) and 16 females (40%) with a mean age of 48 ± 12.5 yrs. In the MM group, there were 30 males (75%) and 10 females (25%) with a mean age of 50.6 ± 17.3 yrs. Patients with grade 3 and 4 prolapsed hemorrhoids were entered in the study. Data were entered using SPSS software and analyzed using t-test and Chi-square test. RESULTS: The two groups had no significant difference in terms of age or sex. Duration of surgery was 35 ± 7 minutes in the SH and 23.6 ± 13.5 minutes in the MM group. This difference was statistically significant (P = 0.000). Post-operative pain and complete pain relief was slightly lower in the MM group (not significant). Hospital stay was significantly longer in the MM group (P = 0.003). Return to work was similar in both groups. Three patients in the SH group (7.5%) and 2 in the MM group (5%) had hemorrhoid recurrence. CONCLUSIONS: Both techniques are efficient treatment methods for grade III and IV hemorrhoids and are associated with greater than 95% recovery rate. Overall, outcomes are the same in both techniques. Lower postoperative pain was the only advantage of SH over MM technique.

Thoracoscopic Sympathicotomy vs Sympathectomy in Primary Hyperhidrosis.

BACKGROUND: Primary hyperhidrosis (P.H.H.) is characterized by excessive sweating in certain parts of body. It's estimated prevalence is 0%-6.1% in different populations. In Asian population its prevalence is around 3%. In 57% of cases, there is a positive family history. OBJECTIVES: To evaluate and compare the early and late satisfaction, outcomes and complications of thoracoscopic sympathectomy and sympathicotomy in the treatment of primary hyperhidrosis. MATERIALS AND METHODS: From April 2007 to January 2011, we prospectively treated 60 primary hyperhidrosis patients via thoracoscopic surgery. The first 30 patients underwent sympathectomy and the next 30 patients underwent sympathicotomy. We evaluated early and late satisfactions, outcomes and complications on the first visit (5-8days) following surgery and 12 months after surgery, for all patients. RESULTS: The mean operative time was 66.3 minutes in sympathicotomy group and 110.8 minutes in sympathectomy group (P < 0.001). There were no significant differences between the two groups in overall early and late satisfaction, gustatory sweating, pompholyx and post-operative pain. There was comparatively less early and late compensatory sweating (C.S.), and other adverse influences of C.S. in the sympathicotomy group. CONCLUSIONS: Because of shorter operative time, less C.S. and less adverse influence of C.S., sympathicotomy seems a better treatment for primary hyperhidrosis, compared with sympathectomy.

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy.

BACKGROUND: Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time. OBJECTIVES: The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method. MATERIALS AND METHODS: IN THIS RANDOMISED CONTROLLED CLINICAL TRIAL, MALE PATIENTS WITH UNILATERAL INGUINAL HERNIA WERE RANDOMIZED INTO TWO GROUPS: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis. RESULTS: All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery). CONCLUSIONS: Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy.

Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: a cross-sectional study.

INTRODUCTION: Acute appendicitis (AA) is still the most common acute surgical disease. While negative appendectomy (NA) is inevitable, one of the greatest challenges a surgeon faces when treating patients with a primary diagnosis of AA is to decrease NA without increasing the morbidity and mortality rates. This study was conducted to evaluate the frequency of symptoms, signs, laboratory data and the diagnostic values of these findings as regards avoiding NA in patients with a primary diagnosis of AA. METHODS: In a cross-sectional study, 1197 patients with a primary diagnosis of AA who underwent open appendectomy in two general military hospitals with a primary diagnosis of AA were evaluated over a two-year period. Data were compared between the two groups; namely those with AA and the ones with NA. Statistical analysis was performed using one-way ANOVA, Kappa and odds ratio correlation coefficients and the logistic regression model. RESULTS: The mean age was 24.1+/-0.25 years. There were 911 (76.1%) males. Rate of NA was 18.2%. The regression model revealed that being younger (<21 years old) (P=0.049), being female (P=0.001), having a lower percentage of polymorph nuclear (PMN) cells (P=0.024) and a lower heart rate (P=0.021) could be regarded as independent predictors of NA (P<0.001). CONCLUSION: Obtained results indicate that female gender, low PMN percentage and pulse rate, and age below 21 years can provide important diagnostic information in addition to other diagnostic workups to prevent unnecessary laparotomies.

Earthquake related injuries: assessment of 854 victims of the 2003 Bam disaster transported to tertiary referral hospitals.

BACKGROUND: In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. OBJECTIVE: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran. METHODS: The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed. RESULTS: There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value +/- SD for ISS was 6.7 +/- 5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14). CONCLUSIONS: Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.