Evaluation of the Effect of Reduction Mammoplasty on Body Posture in Patients with Macromastia.

Background: Breast hypertrophy is a significant health problem with both physiological and psychological impacts on the patients' lives. Patients with macromastia adopt a corrective posture due to the effect of the breast on the center of gravity and possibly in a subconscious effort to conceal their breasts. Objective: This study aimed to evaluate whether the posture of patients with macromastia changed after the reduction of mammoplasty. Material and Methods: In this prospective study, patients with breast cup sizes C, D, and DD were scheduled for reduction mammoplasty in 3 Shiraz University Hospitals. Age, weight, height, and preoperative cup sizes of the breasts were recorded for every patient, and all patients underwent posture analysis with forceplate before and after reduction mammoplasty. Finally, the preoperative and postoperative data were compared. Results: Mean age at the time of reduction mammaplasty was 43.57±9.1; the mean pre-operation, such as weight, height, and mean the body mass index (BMI) was 76.57±10 kg, 158.28±6 cm and 30.57±4.1, respectively. The average Anterior-posterior (AP) direction velocity before and after the surgery was 0.85±0.12 cm/s and 0.79±0.098, respectively. These values were 0.83±0.09 and 0.81±0.10 for the mediolateral direction. The Detrended Fluctuation Analysis (DFA) value for the AP direction was 1.63±0.3 and 1.60±0.2 for pre-and post-surgery, respectively, which was not statistically different. The DFA value for maximum likelihood (ML) direction was 1.65±0.2 and 1.48±0.2 in pre-op and post-op, respectively, which was statistically significantly different. Conclusion: Reducing the weight of enlarged breasts can correct disturbed sagittal balance and postural sway.

Recurrent abdominal wall endometriosis at the trocar site of laparoscopy: A rare case.

BACKGROUND: Surgical scar endometriosis is typically presented as a slow-growing, painful abdominal mass near the site of a past surgery. Endometriosis on the trocar port site is rare. To best of our knowledge, only 17 cases have been reported in the literature. The nonspecific nature of endometriosis presents a diagnostic challenge, and it is often considered as an incisional hernia or other conditions. CASE: Here, we described our experience with a recurrent abdominal scar endometriosis case at the trocar port site of a previous laparoscopy, which was initially thought to be an incisional hernia. CONCLUSION: Abdominal wall endometriosis should be considered as an important differential diagnosis in females with a positive history of prior abdominal surgery, presented with painful nodule or mass at the site of the surgery.

Surgeons and surgery from ancient Persia (5,000 years of surgical history).

The development of surgery is indebted to scientists and surgeons from various civilizations throughout history. The present study considers surgery in the ancient Persian civilization. It highlights aspects of the subject, such as findings of the first trephinated skulls in Iran; surgeons' social class (kareto baesaza in the Avestan language-dating back 3,000 years); surgical operations such as cesarean section and procedures to treat breast cancer; and the use of anesthetic compounds and surgical practice in the military. It is hoped that this catalogue of historical evidence of surgical practice in ancient Persian civilization will contribute to the history of surgery, as an important field in medical science.

Tracheal reconstruction by re-inforced Gore-Tex in esophageal submuscular tunneling: An experimental study.

BACKGROUND: Tracheal reconstructions are aimed at rearranging or replacing parts of the tracheal tissue by different techniques. Here we introduce a new technique for tracheal reconstruction. METHODS: In 10 adult dogs, after intubation with an endotracheal tube, a segment of trachea including seven tracheal rings was resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. The esophageal submuscular tunnel starts and ends exactly at the level of distal and proximal ends of tracheal resection, respectively. Inforced Gore-Tex passed through the esophageal submuscular tunnel the distal segment of trachea and end-to-end anastomosis were made between distal ends of Gore-Tex and trachea, then endotracheal tube removed and the same procedure was made for proximal ends of Gore-Tex and trachea. Afterward, the proximal and distal ends of the esophageal tunnel were approximated to proximal and distal tracheal parts over the anastomosis. RESULTS: All dogs, except one due to anesthetic problem, survived and tolerated the operation; the first two dogs experienced postoperative fever, aspiration pneumonia, and died due to tracheoesophageal fistula. All survived animals were eating and barking well. We started to scarify dogs at least 6 and 12 weeks after operation for microscopy and pathologic examination. The Gore-Texes were patent and supported externally with fibrous connective tissue in esophageal tunneling, with in growth of respiratory epithelium on inner surfaces. CONCLUSION: Air tightness, good re-epithelialization, and relatively no limitation of esophageal length and no risk of luminal collapse are advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement.

Alpha particle vascular brachytherapy in the treatment of in-stent Restenosis.

In-stent Restenosis (ISR) is the Achilles heel for using of stent. Vascular brachytherapy (VBT) has been the principal scientifically investigated local therapy for coronary artery ISR. In our suggested method, a new type of stent, which is coated with Boron ((10)B) compound, is used. The coating layer of the stent consists of stable isotype of (10)B. Boron Neutron Capture Therapy produced alpha particle has enough energy to kill the cells adjacent to the stent, which is the site of boron deposition. It would prevent from ISR and intimal proliferation. After percutaneous coronary intervention (PCI) and insertion of stent, follow-up should be done continuously, and if ISR is detected, BNCT will be used to treat the recurrence. Using this modality of VBT would help us to overcome the pitfalls in en vogue radiotherapy methods.

Does auricular acupuncture reduce postoperative vomiting after cholecystectomy?

PURPOSE: To find the efficacy of auricular acupuncture for the prevention of postoperative nausea and vomiting after cholecystectomy. MATERIALS AND METHODS: One hundred (100) female patients undergoing transabdominal cholecystectomy were randomly allocated to two groups of 50 (auricular acupuncture treatment group and nontreatment group) in order to test the effectiveness of auricular acupuncture. Statistical significance (p < 0.05) was determined using an unpaired t-test for age, weight, height, and duration of anesthesia; a chi-square test was used to analyze the incidence of vomiting. RESULTS: There was no significant difference in age, weight, height, or duration of anesthesia among the two groups of patients. There was a significant difference between the control and auricular acupuncture treatment groups in the incidence of vomiting 24 hours after surgery (66% and 0%, respectively, p < 0.01). No noteworthy side effects from treatment were observed. CONCLUSION: Auricular acupuncture is effective in reducing vomiting following transabdominal cholecystectomy in female patients.

Central corneal thickness as a risk factor for glaucoma.

Glaucoma is the second leading cause of blindness worldwide. It has many risk factors such as age, race, sex, intraocular pressure, optic nerve changes, corneal thickness, refractive error, systemic diseases, family history and trauma. Central corneal thickness plays an important role in risk stratification among patients in whom glaucoma was of concern. Scleral thickness and central corneal thickness have a moderately positive correlation. Stress is responsible for glaucoma and causes deformations of the retinal layers and the consequent high levels of neural tissue strain. Stress and scleral thickness have inverse relation together and since scleral thickness is related to central corneal thickness positively, stress is related to central corneal thickness inversely. Risk of progression of glaucoma damage has an inverse relation with the central corneal thickness. This hypothesis is provable via two ways: (1) Based on formula of stress, when central corneal thickness decreases, the amount of stress increases inversely. This leads to more interruption of retinal layers and consequent higher levels of neural tissue strain that increases the risk of suffering glaucoma. (2) Variations of central corneal thickness lead to misestimation of intraocular pressure with Goldmann applanation tonometry. Underestimation of intraocular pressure may lead to underdiagnosis and consequently undertreatment of glaucoma. In conclusion central corneal thickness is a powerful predictor for risk of progression of glaucoma in population. So it should be added to routine clinical examinations for screening of glaucoma. Our hypothesis answers the question about relationship between increased susceptibility to glaucoma damage in patients with thinner corneas.

Life in death: an overview of solid organ transplant in Shiraz, Iran.

Advances in organ preservation, immunosuppression, and surgical procedures have resulted in improved outcomes and survival rates. However, regarding organ transplant in different communities, these advances raise major ethical, policy, and religious issues. Transplant progress in Iran, in relation to the rest of the world, has been slow at times and quick during others. Between 1988 and 1993, there was a rapid surge in experiments with tissue transplant in Iran, and the Shiraz Organ Transplantation Center, established in 1988, rose to become a pioneer of the most significant improvements, a leading center for organ transplant, and the only center for liver transplant in Iran. In this article, we review milestones in the development of a successful organ transplant program and implementation of legislation in Iran. The Shiraz model of transplant is a new program that attempts to overcome the problems of organ shortage. We provide a description of the Iranian model of transplant and its restrictions and examine the most promising future trends in this exciting field.