Shiraz Emedical Journal
Volume:9 Issue: 4, Oct 2008

Laceration around the joints may penetrate the synovial membrane barrier and contaminate the joint. Determining the penetration of the synovial membrane is important to the diagnosis. Saline load test has been used in the past to diagnosis penetrating joint injuries but the efficacy and safety of the test have not been determined. This study was designed to evaluate accuracy and safety of this procedure in penetrating periarticular injuries. Between April 2002 till March 2003, 100 cases of Periarticular injuries to large joints with possibility of intra articular extension were studied. Clinical examination performed to determine the possibility of penetrating into the points. Then saline load test was performed by injecting appropriate qualities of saline into the joint, depending into the size of joint, watching for extravasations of saline with joint at rest and passive motion. Two weeks later patients examined in out patient clinic for evidence of any complications related to the test. the ratio of male to female was 19:1; the mean age at the time of injury was 27.4. Eighty two percent of injuries were due to road traffic accident, the knee was involved in 68% of cases. In 47 patients saline load test was positive. In 38% of them the result of clinical examination had predicted that the joint space might not be open to exterior. In 28% of 53 patients in whom saline load test was negative clinical prediction had indicated an open joint injury. Overall, the result of saline load test had changed the treatment planned on the basis of clinical prediction in 33% of patients. There was no complication related to the procedure. decision making to operate or not the basis of clinical examination is risky and can have dangerous consequences. Saline load test is a safe and reliable method for diagnosis of intraarticular penetration of penetrating lacerations.

Caudal block offers a good and safe postoperative analgesia in pediatric patients. In a randomized study we have examined the characteristics and mean duration of analgesia after caudal anesthesia performed with two different routes: trans-sacral and trans-sacral hiatus. Forty boys in Ali-Ebne-Abitaleb Hospital of Zahedan undergoing hyspospadias repair were randomly allocated in two groups to receive bupivacaine 1.5mg/kg from sacral route in one group and from sacral hiatus route in the control group. Postoperative pain and sedation scores were assessed for 12 hr after operation. The time of first requiring of additional analgesia did not differ significantly between two groups (365±40 min in sacral group vs 390±35 min in trans-sacral-hiatus group) (P value=0.17). Side effects were not seen in any patients. Two groups were comparable with regards pain scores and sedation scores at 1 and 7h (P > 0.05). We concluded that the trans-sacral route is an acceptable, safe and easy method for performing caudal block, but total duration of analgesia did not differ with these two methods.

Duration and remainder scar are two important problems in process of surgical wound healing, especially in low midline incisions that usually have more duration and wider scar in their healing process. The aim of this study was a comparison between Honey and Povidone Iodine in surgical wound healing, because of Honey is the world’s oldest known wound dressing and there are several reports from its antibacterial properties and stimulating effects on wound healing process. This clinical trial study was performed on 40 female Rabbits that were non-pregnant, 5 months aged with average weight of 1900 grams, belonging to Albino race, in Animal Institute in Tehran, Iran in the year 2006. For beginning, Rabbits were divided into two equal groups randomly, and then similar surgical incisions 10 cm traced were applied after appropriate shaving and local anesthesia on exterior area of right thigh of all rabbits. Then all Rabbits wounds sutured by Silk 2.0 separately and were covered similarly. Covering of wounds in two groups were changed every 12 hours and wounds were dressed with 5 ml of purred natural Honey in first group and in the second group irrigated with 5 ml of Povidone Iodine 10% in every time. The findings were recorded and analyzed with SPSS software by using of chi-square and t test, p<0.05 was considered as significant. Appropriate wound healing in Rabbits 4 days after surgery was significantly different in Honey and Povidone Iodine groups (17/20 or 85% vs. 8/20 or 40%, p=0.0032), in 7th days after surgery this differentiation was significant also (20/20 or 100% vs 11/20 or 55%, p=0.0072). Width of scar 2 weeks after surgery was significantly different in two groups too (2mm SD±1 vs. 5mm SD± 1, p= 0.0043). Use of Honey as wound dressing after surgery reduces duration of healing and width of scar more than Povidone Iodine and it’s a good alternative for stimulating and improvement of surgical wound healing.

Breast core needle biopsy (CNB) provides enough tissue for histopathologic diagnosis and is considered a reliable method for establishing preoperative tissue diagnosis. The purpose of this study is to evaluate CNB as the first diagnostic step instead of excisional biopsy in palpable breast masses. In this prospective study, patients with palpable breast mass who underwent CNB were enrolled. Based on pathology report, patients with malignant lesions revealed by CNB were immediately candidate for surgery and those who had benign lesions were followed up to 3 years. 112 females with palpable breast mass were enrolled in the study. In 103 (91.9%) of cases first attempt CNB provided adequate sample tissue. CNB detected malignant lesion in seventy eight (69.6%) patients. All (100%) malignant CNB reports were confirmed at surgery specimen pathology. In 34 (30.4%) patients CNB revealed benign lesion. At the end of 3 years follow up period, 25 (73%) of these patients underwent open biopsy leading to the detection of 1 (3%) malignant tumor. Overall, according to the gold standard defined as positive surgical biopsy or positive follow-up, sensitivity of CNB was calculated as 98.7% (95% CI, 94.1-100%) and its accuracy was 99.1% (95% CI, 97.4-100%). The specificity of the CNB procedure was 100%. These findings suggest that the malignancy detection power provided by CNB may be weighed equal to that of open biopsy. Therefore, we propose CNB as the first choice in diagnostic evaluation of palpable breast mass especially for those in accessible sites and in experienced hands.