Potassium permanganate in treatment of diabetic foot ulcer: A randomized clinical trial.

Background and Aims: Diabetic foot ulcers (DFU) are a severe complication in diabetes patients, often resulting in significant morbidity and mortality due to non-healing. This study investigated the effectiveness of 5% topical potassium permanganate on these ulcers. Methods: A clinical trial was conducted on 23 patients with Wagner grade I and II DFU. Patients in the control group received standard treatment, while those in the intervention group also received 5% potassium permanganate topically. Data were recorded at 0, 7, 14, and 21 days for analysis. Results: Among 23 patients studied, 7 (30.4%) were male and 16 (43.7%) female, with an average age of 59 ± 4 years. Both groups showed a statistically significant decrease in wound size and infection over time (p < 0.001). The intervention group, however, had a more substantial reduction in wound size and infection rate (p < 0.05). Conclusion: Potassium permanganate, when applied topically, is both well-tolerated and effective in enhancing wound healing and reducing infection in DFU, suggesting its potential as a complementary treatment.

Duodenal dislodgement of an ingested sharp foreign body by mucosal unfolding "Gilan maneuver"; A novel surgical approach.

INTRODUCTION AND IMPORTANCE: Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called 'Gilan maneuver' for removal of FB which lodged in duodenal loop. CASE PRESENTATION: An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through 'Gilan maneuver' in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side. CLINICAL DISCUSSION: Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated. CONCLUSION: Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered.

Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure: A New Trauma Scoring System to Predict Mortality in Trauma Patients.

BACKGROUND: Trauma is the most common cause of death in people aged 1 - 44 years and the third leading cause of death regardless of age. Early diagnosis can expedite emergency care and thus patients can be transferred more quickly to a treatment center. OBJECTIVES: The purpose of this study was to evaluate the mechanism of injury, Glasgow coma scale, age, and arterial pressure (MGAP) scoring system in predicting mortality in trauma patients. PATIENTS AND METHODS: In this cross-sectional study, 5,484 victims over 12 years of age referred to a trauma referral hospital and were evaluated. The MGAP score was assessed based on type of injury, Glasgow coma scale (GCS), systolic blood pressure (BP) and patient's age. The area under the receiver operating characteristic (AUROC) curve was used as a measure of predictive performance. Data were analyzed using SPSS software version 16. RESULTS: Patients were divided into three groups : scores of less than 18, 18 - 22 and greater than 22; in which the mortality rates were 75.2%, 9.5% and 0.1%, respectively (P < 0.0001). The best cut-off point was 22 in our study, and the MGAP scoring system had 93.7% sensitivity and 91.3% specificity. CONCLUSIONS: The MGAP scoring system can be used as an appropriate scoring system to predict mortality in triage trauma patients.

Comparison of the results of total thyroidectomy and Dunhill operation in surgical treatment of multinodular goiter.

Multi-nodular goiter (MNG) is one of the commonest thyroid gland disease. Surgery is an important treatment option in the presence of indications. There are several alternative procedures for thyroid gland operation such as subtotal thyroidectomy (STT), near-total thyroidectomy (NTT), hemi-thyroidectomy plus subtotal resection (Dunhill procedure), and total thyroidectomy (TT), but the surgical procedure of choice is still under discussion. In this study, 173 consecutive patients with multi-nodular goiter underwent thyroid operation in the department of surgery of Pursina Hospital in Rasht-Iran, using two different methods: Dunhill operation and total thyroidectomy. Outcome assessment was performed 4 days after surgery, 2 weeks, 1, 2, 10, and 20 month after surgery. Preoperative assessment, seroma, recurrent laryngeal nerve palsy, hypocalcaemia rates, and rates of other postoperative complications, final pathology, and recurrence were compared in two methods. Due to the high incidence of malignancy in this survey, TT can be the method of choice for MNG surgery. Also, TT will be more beneficial in the surgical treatment of benign thyroid disorders, especially those which are bilateral or extended to substernal space or which presented with compression symptoms.

Serial Clinical Examinations of 100 Patients Treated for Anterior Abdominal Wall Stab Wounds: A Cross Sectional Study.

BACKGROUND: The current approach in stab wounds of the anterior abdominal wall is still unclear. OBJECTIVES: The goal of this study was to evaluate serial clinical examinations of patients with abdominal wall stab wounds referred to Poursina Hospital in Rasht. PATIENTS AND METHODS: In a cross sectional study, 100 cases with stab wounds to the anterior abdominal wall were examined serially (admission time, 4, 8, 12, and 24 hours) after wound exploration. Serial hemoglobin test was performed every 8 hours. Laparotomy was performed in cases who were not hemodynamically stable or who showed symptoms of peritonitis. The results were analyzed with SPSS software version 21. RESULTS: Ninety-one men (91%) and 9 women (9%) with mean age of 27 ± 10.7 years were included. Coexisting injuries were prevalent in 12 cases. The duration of hospitalization was 1 day in 31%, 2 days in 30%, 3 - 4 days in 32% and more than 5 days in 7%. Late laparotomy was performed 12 hours after admission in 8% of patients due to peritonitis. There was visceral damage in these cases. No mortality occurred. The cost and duration of hospitalization was significantly higher in cases with coexisting injuries and those who underwent laparotomy. CONCLUSIONS: It seems serial clinical examinations are safe and decrease the cost and duration of hospitalization in stable patients with anterior abdominal wall stab wounds.

Assessment of Vascular Injuries and Reconstruction.

BACKGROUND: Trauma is the third leading cause of death. In this regard, vascular injury plays a leading role in of morbidity and mortality rates. OBJECTIVES: The present study aimed to assess the prevalence of vascular injuries and results of vascular reconstruction at a referral hospital in northern Iran. PATIENTS AND METHODS: A retrospective observational study assessed 88 consecutive patients with vascular injury admitted to Poursina Hospital, Rasht in northern Iran, from October 2007 to October 2009. All study information was collected retrospectively from hospital charts. RESULTS: Most of the affected patients (87/88) were male with a mean age of 29.12 ± 11.20 years. The mechanism of injury in 39.8% was blunt trauma and penetrating trauma in the rest. Of the 53 injured by penetrating trauma (60.2%), the most common cause was stabbing (94.3%). The most common cause of blunt trauma was road traffic accidents (93.1%). The most common mechanism for vascular injuries in upper extremities was penetrating trauma (86.0%) and in lower extremities was blunt trauma (60.0%). Fasciotomy was performed in 16 patients (18.2%) mostly in the lower extremities. Major amputation was required in 10% of the patients. In upper extremities, the most common type of revascularization was end to end anastomosis, followed by inter-position graft. The most common type of reconstruction in the lower extremity was bypass graft. All patients who underwent major amputation were admitted to the center with a delay of more than 6 hours after injury. CONCLUSIONS: Major vascular injuries in our center occurred in young men, frequently because of stab wounds. Popliteal injuries mostly caused by motor vehicle accidents was the second most common arterial injury, followed by combined ulnar and radial injuries. Vascular reconstruction in the first hours after trauma may prevent many unnecessary and preventable amputation procedures.

Anatomical variations of the saphenofemoral junction in patients with varicose veins.

Varicose veins are an extremely common medical condition (present in 5-30% of adults). Surgery remains the gold standard of care in patients with varicose veins, however several newer interventions have been recently introduced which need to be evaluated. During the standard surgery it is imperative to demonstrate and ligate the tributaries of the saphenofemoral junction in combination with stripping of the great saphenous vein. We studied 228 patients with varicose veins who underwent surgery during two years. The number and name of tributaries at the saphenofemoral junction, presence of external pudendal artery and its relationship to the saphenofemoral junction were recorded. The number of tributaries varied from 2 to 7 at the first five centimeters of the great saphenous vein. The average number of branches was 3.87 and the most common branch was the superficial external pudendal vein. The external pudendal artery was identified during all surgical exploration. It crossed anterior to saphenofemoral junction in 39.5% and posterior in 60.5%. Anatomical variations in venous branches at the saphenofemoral junction are varied (from 2 to 7), so it is recommended to explore the location of varicose veins precisely to ensure appropriate surgical technique.

Arterial damage accompanying supracondylar fractures of the humerus.

BACKGROUND: Arterial damage is sometimes associated with supracondylar fractures of the humerus. Diagnosis and careful management of the fracture and arterial repair is crucial. OBJECTIVES: The aim of this study was to determine the prevalence and outcome of supracondylar fractures of the humerus with signs and symptoms of limb ischemia, before and after arterial decompression or arterial reconstruction. MATERIALS AND METHODS: From September 2004 to July 2010, 225 consecutive patients with supracondylar fracture of the humerus were prospectively recruited. RESULTS: From among 75 cases with Gartland type III fractures, 22 were found to have vascular injury.. Of the 22 cases with vascular injury, 7 patients underwent arterial reconstruction. The other 15 received arterial decompression. All patients had a satisfactory outcome. CONCLUSIONS: A high level of suspicion and careful clinical evaluation leading to an early diagnosis and management of vascular injury accompanying supracondylar fracture is very important to prevent unnecessary sequelae ranging from limb claudication, and compartment syndrome to more severe complications like Volkmann's contracture and even limb loss.