فهرست مطالب شیرزاد نصیری

This study assessed the causes of infection in cholecystectomy and compared the infection rates between the open and laparoscopic cholecystectomy.
This was a retrospective cohort study, performed on all patients admitted to Shariati Hospital since February 2017 for cholecystectomy. Initially, the patients were evaluated for infection risk factors, and then surgical site infection rates in these individuals were measured. Infection was assessed at the time of patients discharge (in the first few days after surgery) and again a month later, either in clinic or by phone. Information from 81 patients was collected, and SPSS software version 24 was used to analyse the data using appropriate statistical tests. Statistical significance was defined as p value The mean age of the participants was 45.89 ± 13.38. The relationship between surgical site infections (SSI) and age, sex, comorbidities (diabetes, hypertension, ischemic heart disease, malignancy, chronic lung disease, and chronic kidney disease), taking corticosteroids, smoking, and the emergency or elective nature of the surgery was not significant. The mean age of the patients who underwent open cholecystectomy was higher than the laparoscopic group (p = 0.005). Similarly, the average hospitalization period for those underwent open cholecystectomy was higher (p = 0.03). Finally, the infection rates for open cholecystectomy were 6 times higher than laparoscopic surgeries (RR: 6.11).
There was no significant relationship between SSIs and the risk factors assessed in this study. However, infection rates were higher in the open cholecystectomy group. More studies on the various risk factors of infection and the differences between the laparoscopic and open surgical methods are required.

Thyroid cancer is the most common endocrine malignancy. Accounting for approximately 1-2% of all cancers. Thyroid cancers have been divided into four main types: papillary, follicular, medullary and anaplastic. The active form of vitamin D (1,25- (OH) 2-vitamin D3) by binding to its receptor, using genomic and non-genomic mechanisms inhibits the proliferative effect of TSH on thyroid cells. Therefore, vitamin D may have a role in regulating of thyroid gland cell proliferation. Many studies have shown anti-cancer effects of vitamin D in cancers. Polymorphisms of Vitamin D receptor can influence the prevalence to various cancers. In the present study, serum level of vitamin D and FokI, BsmI and Tru9I polymorphism of vitamin D receptor was investigated.
This case-control study was performed in the summer of 2015 in Endocrinology and Metabolism Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Forty medullary thyroid cancer patients and 40 healthy controls were investigated. Genomic DNA of subjects was extracted with saturated salt/proteinase K and polymorphisms of vitamin D receptor gene investigated by polymerase chain reaction-sequencing. Serum level of vitamin D evaluated by ELISA technique. The results were analyzed by SPSS, ver. 20 (Chicago, IL, USA) and GraphPad Prism, ver. 5 (GraphPad, Inc., CA, USA) softwares.
Genotypic and allelic abundance of FokI and BsmI polymorphisms between test and control groups have not shown significant different. In Tru9I polymorphism, Tt genotype abundance in test group were 45 percent and in control group were 17.5 percent and t allelic abundance in test group were 25 percent and in control group were 8.7 percent which this different were significant. Average serum level of vitamin D in test group was 23.32 ng/ml and in control group was 18.95 ng/ml which was statistically significant.
Unexpectedly, serum levels of vitamin D in test group were higher than control group. Tru9I polymorphism is significantly correlated to medullary thyroid carcinoma prevalence.

Introduction & Pain control is one of the main issues in laparoscopic surgeries. Although opioid and non-steroidal anti-inflammatory drugs (NSAIDS) are used for pain control but there are severe side effects, but it is thought that, new generation of NSAIDS are able to control pain without any significant side effects of narcotics. We compared postoperative pain, analgesic administration, duration of hospital stay, and side effect of surgeries such as vomiting. From September 2008 to March 2009, we enrolled 75 laparoscopic cholecystectomy patients in a randomized clinical trial study. The patients were randomly divided into two groups. In intervention group, 200 mg for celecoxib administered one hour before surgery and then 200 mg each 12 hours, for two days after surgery. Placebo was administered in the control group. Then severity of pain was measured by visual analogue score (VAS) every six hours during 48 hours. Opioid consumption, duration of hospital stay, antiemetic usage, and other complications of surgery (such as nausea and vomiting) were recorded. Statistical analysis was performed with SPSS version 16.0. Data were reported as means and SD. Data with normal distribution was tested with independent t-test. Qualitative data was analyzed with chi-square. Means of pain intensity were analyzed with repeated measures anova. P

Introduction & Pain control after surgery is one of the important issues in postoperative care. Pain alleviation leads to patient satisfaction, faster recovery, and improvement in the function of cardiovascular, respiratory, and gastrointestinal systems. Pain control with anesthetic substances administration in the wound through catheter, is one of the methods which is under study. In this study we assessed Bupivacaine administration in the wound through catheter between and over rectus fascia after midline laparotomy. In this study, after informed consent, the patients were divided into three groups. In one group, a catheter was placed between fascias of each rectus muscle. In other groups two catheters ware placed over fascia, after fascia repair. In first two groups, 5cc Bupivacaine 0.25% was administered through each catheter. In third group, normal saline was used and when patients suffered server pain, 50mg pethidine was administered. Pain score was assessed by visual analogue score and narcotic use and post-operative recovery were compared in the three groups. For statistical analysis, the proportions were compared using chi square test. The continuous variables were compared with ANOVA test followed by Dunnett post-test for significance. All 90 patients under study were similar according to age, gender, incision length, literacy level, and cooperativeness. Pain scores in three groups were different (P < 0.0001) and pain was less in patients with catheter in their wounds. Dose of pethedine administration in patients with catheters between rectus fascias, over fascias, and the control group were 250±97.3, 293.2±135.7, and 357±116.6 milligrams respectively (P=0.01). Time of return of bowel sound and gas passage, and hospital stay after surgery were longer in the central group than the other two groups significantly. No wound complication was seen in patients with catheter. There was no significant difference between the two groups with catheters. Bupivacaine administration with catheter in surgical wound after midline laparotomy can reduce pain. This method can reduce period of ileus and hospital stay without major complications. Inserting Bupivacaine catheter between rectus muscle fascias was not significantly beneficial and needs more studies.

Introduction & Colorectal carcinoma is one of the most prevalent cancers. Early diagnosis and diagnosis in primary stages are important in patient’s prognosis. In this study we evaluated factors such as age, sex, stage and tumor location in colorectal patients in five year peroid. From the cancer database of a single referral institution, Shariati Hospital 109 patients who had resection of colorectal cancer from 1999 to 2002 were identified. Cases with recurrent colon cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were constructed using the kaplan-meier method. The factors that were used included: age, sex, TNM stage, T-status, nodal status, distant metastasis, grade, lymphatic and vascular invasion, tumor location, preoperative CEA level and liver function tests. Multivariate analysis of factors was conducted using cox-regression analysis. The mean survival time for all patients was 42.8±2.8) months. The overall 1, 3, 5 year survival rates were 72%, 54%, 47% respectively. The single variable analysis, patients age (P

Introduction & To determine the relationship between serum phosphate, serum calcium, and serum parathyroid hormone levels with parathyroid adenoma weight and postoperative serum calcium in primary hyperparathyroidism. In a prospective study from 2005 to 2007, eighty patients with single parathyroid adenoma entered the study. Preoperative serum calcium, phosphate, parathyroid hormone, alkaline phosphatase and weight of adenomas were recorded. Postoperative serum calcium was measured 24 hours after adenoma resection. Analysis was performed with student T-test and Bivariate correlation. The level of significance was set at P

Introduction & Bilateral neck exploration is the good standard for parathyroid adenoma localization in primary hyperparathyroidism. But not all of surgeon have the necessary experience for accurate surgical exploration. But there are new methods for surgery like unilateral exploration and minimally invasive surgery. Thus, preoperative localization could reduce time and stress of surgery. In a prospective study 80 patients with documented primary hyperparathyroidism through raised serum calcium and parathyroid hormone (PTH), the results of sonographic localization were compared with the findings of surgery and 99mTechnetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients whom adenoma had been localized or not localized through sonography or Sestamibi scan with student’s t-test. In a prospective diagnostic tests accuracy study, 80 patients with primary hyperparathyroidism enrolled. Sonography detected enlarged parathyroid glands in 61 of 80 patients (76.3%), with sensitivity of 83.5% and positive predictive value (PPV) of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients (78.8%) with sensitivity of 85% and PPV of 91.3%. There was no significant deference between sonography and scintigraphy in localization of adenomas. When both sonography and scintigraphy were used for localization, they located 73 adenomas (91.3%), with sensitivity of 97.3% and PPV of 93.5%. Sonography is an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, and overall it is comparable with sestamibi scintigraphy. This study suggests a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test gives negative result.

Hydatid cyst is an endemic disease in many parts of the world including our country. It is significant from the viewpoint of public health, political and economic and migration considerations. It can involve any part of human body. In this study we report a case of primary isolated hydatid cyst of omentum which is an unusual location for this disease. To the best of our knowledge this is the first case of primary isolated omental hydatid cyst in Iran. A similar case has been reported in the literature. Due to endemic occurance of hydaid disease in Iran, we review the literature in terms of unusual location of the disease, hoping to strengthen our knowledge about this disease.

Port-site metastasis following laparoscopic cholecystectomy with unsuspected gallbladder carcinoma is a serious problem. Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after histological examination of the gallbladder. The spread of cancer following laparoscopy appears aggressive and widespread, as noticed from re-operation for radical treatment. The pathologic findings of gallbladder were consisting of tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma. Mucosa and submucosa were involved, but no evidence of invasion to muscular layer and gall bladder serosa was found (T1).

Chronic pancreatitis and perivasculitis is the most common etiology of splenic vein thrombosis (SVT). Reported in up to 45% of patients with chronic pancreatitis, SVT may also be seen in patients with acute pancreatitis and pancreatic adenocarcinoma. It causes a localized portal hypertension called sinistral portal hypertension. Unlike those with generalized portal hypertension, patients with sinistral portal hypertension are asymptomatic and have normal liver function. Upper gastrointestinal bleeding from gastric varices is a life threatening complication of SVT. In patients with gastrointestinal bleeding secondary to esophageal or gastric varices, late-phase celiac angiography is used to