نشریه جراحی ایران
سال نوزدهم شماره 4 (زمستان 1390)

Introduction & Cartilage graft is frequently used in plastic and reconstructive surgery to overcome bodily and especially facial deformities. One of the problems of this technique is cartilage absorption. Dicing and perichondrial preservation may afford better reconstructive results. In this study 28 cartilage specimens from male white New Zealand rabbits, roughly weighing 1500-2000 g and being 12-14 weeks old, were used. After standard induction of general anesthesia in rabbits, two pieces of cartilage were obtained from one ear. Two skin incisions were made on both sides of the midline back of the animal and posterior to the shoulder blades. Then one specimen was diced and inserted on one side. The second piece of the rabbit’s ear was diced in a way that perichondrium was preserved on one side. This specimen was also inserted into a subcutaneous pocket on the other side of the rabbit. After 3 months and by standard sacrifice of the animals, the two specimens were removed and reweighed. Finally the results of standard weighing of the cartilages were compared. The weights of the two groups (cartilage graft with and without perichondrium) were measured at the beginning of the study. They were not significantly different (P-value 0.21). Then the results were compared three months after the operation. That showed a significant (P-value 0.019) increase in the weights of perichondrially attached cartilage compared to the cartilage graft without perichondrium. Nevertheless, using paired t-test at the beginning of the grafting and three month after revealed no significant difference between cartilage graft with perichondrium (P-value 0.09) and cartilage graft without perichondrium (P-value 0.19). Perichondrially attached diced conchal cartilage brings about the possibility of forming and securing the whole complex. This method may be utilized as a cover in thin skinned noses, or as a graft to augment the dorsum. If we intend to use concha to augment nasal structure, by means of this technique, we can change the feeble and convoluted ear cartilage to a more versatile tool.

Introduction & Chronic anal fissure is a common anorectal disease which present itself with pain and hemorrhage during defecation. If conservative treatments with high fibers regiments and sitz bath don’t cure the chronic anal fissure, sphincterotomy can be done by open or closed technique. In this study we compare the outcomes and complications of open and close sphincterotomy. In this clinical trial study, 32 patients underwent open sphincterotomy and 29 patients underwent close sphincterotomy. The duration of surgery and hospital admission, post-operative pain and hemorrhage, late complications and recurrence were compared between the closed and open sphincterotomy. The average surgery time of closed and open sphincterotomy were 19.5 ± 5.5 and 45.5±4.84 minutes respectively. The difference was statistically significant (P

Introduction & Twin pregnancy is a high risk pregnancy that leads to four fold increase in fetus mortality rate and six fold increase in neonatal mortality rate. This study, done at Alzahra hospital in Rasht, was undertaken to assess the relative frequency and some associated complications of twin pregnancies in a period of five years. This is a descriptive cross sectional study in Rasht’s Alzahra hospital. The data which were gathered from patient’s records, included age, gestational age, parity, type of pregnancy, route of delivery, gender of neonate, weight of neonate, discordances between twins weights, preeclampsia, GDM, fetal anomaly after collection of data. These were analyzed with SPSS software. The frequency of twins was 1.7% and 53.5% of the females were multipara. The highest frequency of twin pregnancies were in females between 20 to 30 years old (32.1%). Preterm delivery in twin’s pregnancy was 60.4% and prevalence of post term was 0.6%. Weight difference above 25% between twins was 13.2%. The prevalence of fetal anomaly, GDM and preeclampsia were 1.6%, 2.3% and 8.8% respectively. 65.8% of ladies with twin pregnancy underwent cesarean section. 47.9% of neonates were male and the weight of 66.87% was under 2500gr. The complications that affect twin pregnancies have special clinical importance. With diagnosis of those complications, appropriate prenatal care, and the experience of delivery team in providing favorable condition for mother and her fetuses it is possible to prevent complications.

Introduction & Patients with glioma brain tumor are encountered with cognitive and mental changes under the influence of surgery, so that rehabilitation and treatment is required for them. The purpose of current study is to determine the effect of surgery on these impairments. The present cross-sectional study was conducted on 94 brain tumor patients and MMSE, Beck depression and Hamilton anxiety questionnaires were used before and after surgery for cognitive and mental assessment. Before and after surgery, a significant difference was identified in MMSE, Beck and Hamilton tests’ scores (P

Introduction & The purpose of this retrospective study is the assessment of the results of early and delayed surgery in patients who have been operated for ruptured aneurysms, and the cognition of the effective agents and the proper ways for recovery and promotion of treatment methods in these patients. This study is performed retrospectively based on hospitalized information in patient files in Ghaem neurosurgical departments since, 1998 to 2007. In this study we classified personality features, background diseases, the time between hemorrhage to admission, imaging findings in patients with brain aneurysm, time of surgery, kind of surgery, complications and the results of them. 183 Patients were admitted in hospital in 10 years. Most of them were between 50 -60 years old and the mean age was 48.06± 1.48 for men and 50.17± 1.09 for women (overall mean age: 49.05 ±0.88). Hypertension and smoking were the most common underlying factors in these patients. Sudden headache and unconsciousness were the most common symptom and sign after rupture of aneurysms. The most common location for their aneurysms was Ant. Com and MCA. 140 cases (76.5%) were operated upon 21 cases (15%) in first three days and 112 patients (80%) after two weeks. In early operated group, severe complication and death was in 52.4 % cases, but in delayed operated group, severe complication and death was in 15.2% cases. The most common factor in mortality and morbidity in this study were neurologic grades of the patients and the time between aneurysmal rupture to surgery. In this study we have shown that increasing in Hunt & Hess grade, increases morbidity and mortality, and that delayed surgery reduces the mortality and complications after surgery in the patients with brain aneurysmal rupture. Other factors such as diabetes, high blood pressure, addiction and smoking, had no significant relationship with the complication rate and mortality. Although the results of this study and other reports implicate that the mortality, morbidity and complications after early surgery of aneurysms (in the first three days) is more than late surgery, but because some of the patients die from rebleeding or vasospasm before late period, we are still in need of comparing the results of early surgery and outcome of patients in late surgery group.

Introduction & In this article, we have used of Scientometrics we have review and compare 30 years of scientific productivity of Iranian Surgery Community in ISI database. The data of this study have been collected from three sub databases of ISI (Information Sciences Institute). These 3 sub databases are, Science Citation Index (SCI), Social Science Citation Index (SSCI), and Art and Humanities Citation Index (A and HCI). Entering the keyword of Surgery in topic search of ISI database, and Iran in address the retrieved items were analyzed by analyze engine of the database, and then the data were further analyzed by Excel software. Findings show that in the first decade of the study (1980-1989), only 6 documents, in the second decade (1990-1999) only 55 documents and in the third decade (2000-2009) some 1090 documents have been produced by Iranian researchers in this field. Therefore the results show a sharp increase in productivity of Iranian researchers in the field of Surgery. Form the viewpoint of International cooperation, Iranian surgery researchers did not have any cooperation in the first decade of the study. But the results show that in the second and third decade there were considerable international cooperation with researchers of USA, Italy and other countries. Our finding lastly revealed that the language of all document but 2 of them were English. The results show that the scientific productivity of Iranian surgeons has been ascending in these years. The international cooperation too has been increasing, but it has been mostly with USA and Italy.

Renal cell carcinoma is most fatal tumor in genitourinary system. The most prevalent metastatic sites in renal cell carcinoma are; lung, liver, contra lateral kidney, bone and brain. Metastasis to ipsilateral adrenal gland can be seen in more than 40% of the patients and in most of the cases is a part of diffused metastatic disease. Metastasis to contra lateral adrenal is far less common and can be synchronous or metachronous. Diagnosis of ipsilateral involvement of the adrenal is concomitant with diagnosis of the primary tumor, but the diagnosis of contra lateral adrenal involvement is usually done during routine follow ups. Because adrenal metastasis is asymptomatic and patients will not show the symptoms of adrenal insufficiency. The treatment of choice for RCC and it's adrenal metastasis is surgery.