نشریه جراحی ایران
سال بیست و سوم شماره 1 (بهار 1394)

Introduction & Obstructed Deification Syndrome (ODS) is a condition that affects pelvic floor muscle and causes some structural and functional problems in defecation. Rectocele and intussusceptions are known as the two most important causes of this condition. In this prospective study we assessed the outcome of Stapled Transanal Rectal Resection (STARR) in the patients with ODS, and we tried to compare this results with similar studies. This prospective study was performed from April 2010 to March 2012 in the Baqiyatallah hospital in Tehran. All patient underwent STARR for the treatment of ODS enrolled in this study. Preoperative factors like incomplete defecation, straining, using of enema, laxatives, digitations… were assessed. We used Longo’s ODS score for assessment of the severity of pelvic floor’s malfunctions and also, visual analog scale (VAS) for assessing the patient satisfaction. Trans Anal Rectal Resection (STARR) procedure was performed using two circular staplers. All patients had at least one year follow- up after discharge. 33 patients (30 females and 3 male) with an average age of 54, underwent STARR for the treatment of ODS. They had enrolled in this prospective study, and their ODS score was 15.33.1 before surgery and 4.92.3 after surgery (P

Introduction & Multiple hematological changes occur in patients with severe burns. One of these changes is thrombocytopenia that may occur during the treatment of extensive burns for various reasons, including infection. Daily monitoring of platelet count is important in the early detection of infection and secondary complications after extensive burns. In this study, we have evaluated the effects of escharectomy on the platelet counts and the reduction of the mortality rate of extensive burn patients. This cross-sectional study was done on 52 patients with 40-50% burn who were referred to the Shohadaye Yaft Abad hospital. Laboratory data were measured daily, especially platelet count per day were recorded. The platelet count was measured before and after escharectomy in all patients. Paired t test used to compare parametric or equivalent platelet count in both groups before and after surgery and to compare parametric independent t-test or equal to the difference between the platelets before and after surgery were analyzed between groups and all results were analyzed by SPSS 16.0 statistical software. The patients’ mean age was 29.69 ± 16.70 standard deviation. Of these 74% (38 patients) were treated and discharged, but 26% (14 people) of the population died. Given the normal distribution, independent t-test was used to compare the differences which were found to be of no significance (P = 0.091). From the results, it can be concluded that escharectomy surgery in burn patients, both cases of those who died and those who survived, increases the platelet count. But this increase was not significant in either group and can not serve as a determinant of prognosis and mortality.

Introduction & Different methods for dressing of donor site in burnt patients who have similarl pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has been used for the improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for the donor site to evaluate it’s efficacy in the improvement of pain, movement score and the risk of local infection. This study was done as a clinical trial over 32 admitted patients in the burn department of the hospital. Amnion was prepared in the elective caesarean section after ruling out any placental site with routine dressing. Then the two sites were compared about the severity of the pain, movement score, infection and time of dressing sloughing. Fourteen patients were women and 18 men. The mean score of pain and movement up to the sixth post operative day respectively was less than the control site. No difference was seen in the infection and dressing slough in the two sites. It seems that the use of amnion for the dressing of donor site probably causes more rapid epithelialization and wound healing and can improve pain and movement score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization associated with the complication of burnt patients after graft and their early discharge.

Introduction & Diaphragmatic muscle that is responsible for the inhalation, innervations by right and left phrenic nerves. This nerve is a complex and feeds several part of mediastinum. The right phrenic is shorter than the left phrenic and arrived to diaphragm by traveling a different path than the left phrenic. In this study, we evaluated the origin, direction and right and left phrenic nerves and compared them with those offered in reference books and variations have been reported. This study was performed on 22 male and 2 female cadavers. We used simple dissect tools and observed tiny branches by the stereoscope. We evaluated the length of each nerve, relations in various areas, division of branches and terminal fibers. The presence or absence of accessory phrenic nerve was also assessed. For Statistical evaluation, the relevant parameters were recorded in tables. Mean (average) was measured by SPSS 16, and then the average of the sizes were compared. In this study, we observed several variations on the left and right phrenic nerves from what was reported in the previous cases. Considerable differences were observed, in cases such as the pathway nerve of the neck to the chest and the presence of the anterior scalene muscle, passes through the diaphragmatic foramina, a multiple of right and left phrenic nerve branches, the presence or absence of accessory nerve and the phrenic nerve length. Our results showed that the increase in the length of the trunk, and ascending correlation to the left and right phrenic nerve elongation. With respected to the number of cadaver in this study, we showed that there is an accessory nerve in about 30% of the Iranian population. In this evaluation, we provided the different results about the pathway, branches, length and presence of accessory phrenic nerve. However, we found the same results of previous research. The neighborhood of this the nerve is important as in some cases, such as anesthesia and nerve block in the supraclavicular region or between scalenus muscles, the phrenic nerve also suffers from anesthesia. Also, the close proximity of this nerve and infraclavicular vein is very important in surgical operation related to this vein like canal catheter insertion. Since, the phrenic nerve is the only motor nerve of diaphragm, is important to be aware about how to spread the terminal branches of the nerve in the diaphragmatic muscle. Especially considering the fact that most of surgeries in the thoracic and mediastineum is associated with Communications and the organs adjacent to this nerve.

Introduction & Sheen and Constantian defined Bulbous pinch deformity as anterior convexity of LLC dome with posterior depression. This variation includes upward-inward rotation of lateral crura in bulbous tip patients. According to them most of “bulbous pinch” LLCs are positioned toward medial canthus, and so they called it cephalic displacement. They recommended the caudal displacement cartilages for the majority of rhinoplasty cases whom they report as having this variation. Our goal of this study was to measure the angle of lateral crura with fixed points on the face. We marked LLC contours and vertical and horizontal lines on 40 patients’ face and divided them into two groups of bulbous pinch and none bulbous pinch groups. The right and left side angles of LLCs with the midline and horizontal line were measured and were compared to find out if there is any difference between the two groups. There was no statistically significant difference between the two groups. We believe that the real reason behind nasal lateral wall pinching is the convexity of posterior and lateral crura. These findings give us a road plan to correct this kind of nasal tip deformities.

Introduction & Tibial eminent fractures may be seen in all ages but the most common ages for the incidence of these fractures is in children of the 8 to 14 years. Recent studies have shown that the incidence of fractures in the children of normal weight is 16 percent, reaching 33 percent for obese children. Furthermore, epidemiological studies have shown that the prevalence of obesity has doubled over the past three decades. This study was performed to investigate the relationship between body mass index with tibial eminent fractures. In this case-control study, 68 children of the age less than 14 years, who referred to the Beasat Hospital of Hamadan were studied. Of these, 34 were suffering from tibial eminent fractures (case group) and 34 patients who had referred for other reasons were selected as the control group. BMI and type of weight by age and sex for both groups were calculated and compared. The results were analyzed, using SPSS18, variance analysis, T-test, and Chi-squared analysis. The mean BMI in case group was 20.98 ± 3.88 and for the control group was 20.47 ± 2.93 (P=0.544). In the case group 18 patients (52.9%) of had normal weight, 9 patients (926.5%) were overweight, and 7 patients (20.6%) were obese. In the control group 19 patients (55.9%) had normal weight, 10 patients (29.4%) had overweight, and 5 patients (1407%) were obese (P=0.813). The results of this study showed that, children’s weight and body mass index have no significant effect on the tibial eminent fractures.

Introduction & Knowledge and attitude are important factors in predicting health behaviors. Also, they are effective factors in performing screening procedures. We aimed to investigate medical students’ knowledge, attitude and practice about cervical cancer screening method. In this analytic cross sectional study, 368 undergraduate medical students were assessed. Data were collected through a questionnaire consisted demographic characteristics, knowledge assessment (20 questions), attitude assessment (14 questions) and performance assessment (6 questions). Patients were divided in 3 groups based on the acquired score in knowledge assessment: poor knowledge (< 20), moderate knowledge (20-30) and good knowledge (> 30). The attitude questions were designed as 5 degree likert index. Data were analyzed by chi-square test and Pearson correlation coefficient in SPSS software (version 21). 16.6%, 28% and 55.4% of the students had respectively good, poor and moderate knowledge. The most negative attitude was about the necessity of pap smear in those women who had sexual contacts (64.3%) and the most positive attitude was about encouraging family to do the test (82.2%). 100% of married students had referred to a gynecologist in the past 2 years and none of them had Pap smear. There was significant Correlation between knowledge score and age (r = 0.368, P = 0.0001). In the female students, 24.5% had good knowledge, but none of male students had good knowledge (P = 0.0001). There were significant differences between the two gender groups in 12 sentences out of 14 of attitude sentences. 39.6% of intern students had good knowledge, but in other educational levels none of the students had good knowledge (P = 0.0001). Also, there was significant difference between all attitude questions in the three educational levels (P < 0.05). Our study showed that student's knowledge regarding cervical cancer screening test was relatively low, but most people had a good attitude toward it. Also, their performance was relatively poor. So, it is suggested to have more educational programs.

Introduction & Cancer is an old disease and now a global problem. Gastrointestinal cancers are one of the most widespread cancers and influence a lot of people’s life. The purpose of this study is the investigation of personality characteristics and ambivalence over emotional expressiveness in patients with gastrointestinal cancer in comparison with a non-patient group. For comparison of a Patient group with a non-patient group, 100 patients with gastrointestinal cancer were selected from those who referred to Velayat Hospital of Qazvin. The non-patient group was 100 persons mentally and physically healthy and they were sampled from the general population. They were matched demographically with the patient group. Both groups completed the personality characteristics scale (NEO-FFI) and the ambivalence over emotional expressiveness questionnaire (AEQ) test. The collected data were analyzed with MANOVA. MANOVA analysis of these 200 cases showed that there was difference between the patient and non-patient group with α =0.05 in neuroticism, agreeableness, conscientiousness and ambivalence over emotional expressiveness, but in extraversion and openness to experience, there was no significant difference between these two groups. Patients with Gastrointestinal cancer have more scores than non-patient group in neuroticism, agreeableness, conscientiousness and ambivalence over emotional expressiveness.

Introduction & Penetrating head wound are classified according to the velocity of the in-driven missile into; low velocity and high velocity missiles. The low velocity missiles are usually non-bullets, so called ‘cold weapons’. These are the instruments formally used in the work stations not critically controlled for safety. Case report: A 19 year old man suffering from penetrating brain injury (PBI) with a nail in-driven by a pneumatic nailer was referred to the emergency room. His neurological examination was normal. Regular radiological exams and angiograms were done before the operation. The postoperative course was uneventful and the control of cerebral angiogram was also normal. Awareness of the potential harms of the instruments used in the working areas is necessary to prevent possible mortal damages. Even though different studies have tried to elucidate different aspects of PBIs, but there are still poorly defined questions regarding the duration of antibiotherapy, anti-epileptic therapy and the probable duration needed for development of traumatic aneurysms.

While endometriosis is fairly common in reproductive age, the endometriosis of the appendix is very rare.We are reporting about the case of a patient with appendicular endometriosis who was operated for acute appendicitis, but for whom the accurate diagnosis of endometriosis was done after pathologic examination.