فهرست مطالب
Journal of Surgery and Trauma
Volume:8 Issue: 4, Winter 2020
- تاریخ انتشار: 1400/01/08
- تعداد عناوین: 9
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Pages 122-129
The Cabrol shunt has been broadly used to control postoperative heamorrhage in aortic surgery since its first description in 1981. The initial description and its modifications aim to divert the blood from within the aneurysm wrap and/or the periaortic space to the venous system. We describe a modification in the context of central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after complex aortic surgery. A query on the PubMed was carried out using such keywords as ‘Cabrol shunt’, ‘Cabrol fistula’, ‘Aorta-atrial shunt’, ‘Perigraft shunt’, ‘Periaortic baffle’, and ‘Left-to-right shunts’. Original articles and case reports in which patients had undergone a Cabrol shunt or a modification to divert aortic bleeding to the venous circulation in the context of aortic surgery were included in the study. All publications were limited to the English language. On the other hand, abstracts and conference presentations, editorials, and correspondence comments were excluded. Finally, 18 articles and case reports were retrieved. A total of 392 cases of Cabrol shunt or a modification have been reported since 1987 with successful control of postoperative bleeding. Long-term results, when available, prove that the addition of a Cabrol shunt does not negatively affect mortality or postoperative complications, rather it decreases re-operation rates, blood transfusion, and hospital stay. Furthermore, the patency of the shunts beyond the immediate postoperative period has been described. The use of a modified Cabrol shunt in the setting of complex aortic surgery can effectively control peri-operative bleeding. Moreover, its application in other complex settings, such as central VA-ECMO, seems satisfactory.
Keywords: Aorta, Arteriovenous shunt, Consumption Coagulopathy, ECMOTreatment, Surgical, Thoracic -
Pages 130-137Introduction
Clinical education is an ever-lasting requirement in educational settings for students and faculty. However, it is associated with numerous challenges that can have an impact on the efficacy of both the students and the teachers. The challenge can be more prominent in specialized environments such as the operating room. In this qualitative study, we have tried to identify these challenges and provide solutions to them.
MethodsThis is a qualitative content analysis study was performed with the incorporation of seven operating room and anesthesiology instructors of Bushehr University of Medical Sciences. The required questions were first collected and subsequently posed as interviews in the operating room setting. Data were collected through the recording of semi-structured interviews and until the data saturation.
ResultsResearch findings are reported in three themes and nine categories. The main themes were organizational structure, planning, and human resources, each of which with specific categories and/or subcategories as per the subject matter. In terms of organizational structure, the most serious challenges comprised a lack of welfare facilities and problems in the field of education, such as non-specialization of operating rooms and limited physical space. The challenges related to planning comprised of a lack of student self-evaluation, delay in surgery initiation, and a large number of students in various fields. As for the human resource challenges, the most apparent problems were insufficient education delivered to students before their entrance to the operating room and the lack of familiarity of officials with the operating room environment.
ConclusionsGiven the questions posed to and the answers received from the instructors, most of the problems in the operating rooms in terms of education are related to the infrastructure-associated problems in the operating room and the studentschr('39') approach to the operating room. Despite the enormous efforts of the instructors in education, as they were respondents in the study, it could not be clarified how the problems in human resource and teacher dimensions could help solve the overall problems, suggesting that further research is required with the help of students and other groups involved in education in the operating room.
Keywords: Content analysis, Education, Operating Room, Qualitative study, Students -
Pages 138-146Introduction
The durability of a fundoplication (FP) in the treatment of gastroesophageal reflux disease (GERD) in children must be confirmed in the long-term. This study aimed to present the long-term outcome after a minimum of five years.
MethodsPerioperative data were retrospectively reviewed from clinical records, and the follow-up data were collected through a standardized questionnaire. In total, 21 neurologically impaired (NI) and nine neurologically non-impaired (NNI) children were included in this study. The statistical analysis was performed using SPSS software (version 25) through Fisher’s exact test, t-test, and Kaplan-Meier analysis. A p-value of less than 0.05 was considered statistically significant.
ResultsThe median follow-up period was 10.8 years (5-19.7), and the refundoplication rates ranged from 11% to 19%. Revisions were usually necessary within the first two postoperative years. Most delayed refundoplications were necessary for the NI children with a laparoscopic Nissen FP. In the long-term, symptoms and medication administration program were favorable in most cases. Most parents were highly satisfied with the postoperative outcome and would approve that FP is conducted on their child again under the same circumstances.
ConclusionsThe FP is a safe procedure with consistent benefits in the first 10 postoperative years in NI and NNI children with documented GERD. The NI children treated with a laparoscopic Nissen FP necessitate longer postoperative surveillance since more delayed redofundoplications were required in this group.
Keywords: Child, Fundoplication, Gastroesophageal Reflux -
Pages 147-150Introduction
Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle.
MethodsIn this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant.
ResultsBased on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05).
ConclusionsThere was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.
Keywords: Platysma Muscle, Suture, Thyroidectomy -
Pages 151-155Introduction
Appendicitis is a challenging condition for emergency specialists and surgeons to diagnose. If it is not treated in time, the inflamed tissue of the appendix ruptures, causing peritonitis and shock. This study evaluated the diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis.
MethodsThis descriptive cross-sectional study was carried out on a total of 134 patients with suspected appendicitis referring to the Emergency Department of Imam Reza Hospital in Birjand, Iran, within 2013 and 2015 using convenience sampling. The data collection tool was a questionnaire covering patients’ demographics, clinical signs, and laboratory and pathology test results. Sensitivity and specificity, positive predictive value, negative predictive value, likelihood ratio, area under the receiver operating characteristic (ROC) curve (AUC), and cut-off point of each test (i.e., white blood cell, aspartate transaminase, alanine transaminase, C-reactive protein, polymorphonuclear leukocytes, lymphocytes, total and direct bilirubin, iron, and total iron-binding capacity) were analyzed using SPSS software (version 18) and MedCalc software (version 19). A p-value of 0.05 was considered statistically significant.
ResultsIn this study, 68 and 66 participants were male and female, respectively. The mean age of the patients was 24. (44±11).26 years. Pathological examination showed that six patients underwent a negative appendectomy. A positive appendectomy was noted in 128 subjects. Histopathological results confirmed the perforation of the appendix in 78 patients. Among the laboratory tests, only the accuracy of serum iron was fair in the diagnosis of acute appendicitis (AUC numerical value in the ROC curve=0.787). The accuracy of other tests based on the AUC numerical value in the ROC curve was poor or failed.
ConclusionsAlthough the accuracy of serum iron based on the numerical value of AUC in the ROC curve was diagnostically fair for acute appendicitis, it is suggested to carry out further studies with larger sample sizes in order to draw definitive conclusions given the small sample size in this study.
Keywords: Appendicitis, Diagnosis, Signs, Symptoms -
Pages 156-160Introduction
Wound dehiscence is one of the serious complications of surgery that is associated with mortality and morbidity (about 45%); moreover, it increases medical costs. The present study assessed the incidence and predictors of wound dehiscence in trauma patients referred to Hazrat Rasool Akram Hospital.
MethodsThis cross-sectional study was conducted on all trauma patients with penetrating or non-penetrating abdominal wounds referred to Hazrat Rasool Akram Hospital within April 2017-March 2020. Patients were evaluated in two stages, three days after the surgery and one month later. The data were analyzed in SPSS software (version 19) using Fisherchr('39')s exact tests, independent t-test, Pearsonchr('39')s correlation coefficient, and chi-square test. A p-value less than 0.05 was considered statistically significant.
ResultsThe present study included 154 patients with a mean age of 43.53±16.81(age range:16-91 years). Moreover, the majority of the cases were female (n=86; 55.8%). The wound of 20 (13%) patients did not heal. There was a significant relationship between male gender and wound dehiscence (P=0.013). The two groups did not differ in age, smoking, alcohol or opioid use, and the type of surgery. Nevertheless, wound dehiscence was significantly correlated with chemotherapy and the number of sessions. The number of hospitalization days was significantly higher in the group with wound dehiscence (P=0.001). Furthermore, wound dehiscence was closely correlated with low albumin, low hemoglobin, low hematocrit (leading to anemia), and high bilirubin (leading to jaundice).
ConclusionsAs evidenced by the obtained results, wound dehiscence was significantly correlated with gender, low albumin, low hemoglobin, low hematocrit, bilirubin elevation, steroid usage, and chemotherapy history.
Keywords: Penetrating Wound, Surgical Wound Dehiscence, Wound Healing -
Pages 161-163
Very different objects have been reported as foreign bodies in the urinary bladder, which encompasses everything available in the environment, and each one presents a new challenge to urologists. Herein, we report the case of a 21-year-old male patient presented with lower urinary tract symptoms. Two months before his presentation, he had introduced a 110 cm soft electrical wire to his urethra, which migrated into the bladder. Although it has been said that most foreign bodies in the bladder could be endoscopically removed, an attempt to remove this wire by cystoscopy was unsuccessful, and suprapubic cystostomy was performed for the removal. Therefore, it is recommended to consider suprapubic cystostomy the choice of treatment instead of the endoscopic procedure in the case of long and knotted wires to avoid injuries to the urethra.
Keywords: Bladder, Cystostomy, Cystoscopy, Foreign Body, Masturbation, Suprapubic -
Pages 164-167
Pyogenic granuloma (PG) is a common tumor-like growth observed in response to local irritation, trauma, or hormonal disturbances. It is among the frequently encountered oral lesions occurring at the gingiva. Surgical excision and removal of the underlying cause is the preferred method of treatment. Scalpel, cryosurgery, and laser are used in order to remove this lesion. Currently, different lasers are used for the surgery of PG, which include Carbon dioxide; Neodymium-doped yttrium aluminum garnet; Diode; Erbium-doped yttrium aluminum garnet; and Erbium, chromium-doped yttrium, scandium, gallium and garnet. This case report aims to briefly review clinical and radiographic findings of PG along with a detailed discussion on its management through a 980-nm diode laser.
Keywords: Diode Lasers, Excisional Surgery, Pyogenic Granuloma -
Pages 168-172
The occurrence of external cervical root resorption (ECRR) is rare. Herein, we report a case of extensive ECRR in the coronal third of the distal root of a mandibular right molar with food impaction and periapical radiolucency. The distal root was perforated and damaged due to delayed treatment. The resorptive defect was debrided, and the defect was restored with conventionally setting restorative glass-ionomer cement. Postoperative follow-up revealed complete healing.
Keywords: External Cervical Resorption, Endodontic Retreatment, Glass-Ionomer Cement, Surgery