محمد علی حسامی

Introduction & Gastrointestinal perforation is one of the most important causes of emergent surgeries in surgery wards. Demography of peptic ulcer perforation has changed considerably since the first reported case, especially in relation to the age and gender of patients. In the present study, we tried to study predisposing factors in perforation of peptic ulcer, in Hospital of Imam Reza (AS), during 2006 to 2011.
This study was a cross - sectional study, which involves the case studies and complete the registration forms of the patients with peptic ulcer perforation, who underwent surgery at the Medical Center of Imam Reza (AS), during the years 2006 to 2011 were admitted, was done. This form includes variables such as age, use of NSAIDS, alcohol, cigarettes, consumption of PPI and H.Pylori infection. Data were analyzed with the SPSS software.
In this study, 97 (88.2%) were male and 13 (11.8%) were female. The mean age was 47.44 years old with 18.05 SD. The history of smoking was positive in 74 patients (67.3%) and 57 patients (44%) were drugs addicts. Comorbidities were present in 31cases. 25 of the patients had a history of NSAID use and 30 cases (27.3%) had a history of previous perforation of gastric ulcer. Also, all patients with H. pylori history, which were 19% of the study population all had a history of PPI and 24 patients had a history of occasional alcohol consumption. The average length of stay per patient was 7 days.
The most common place of perforation was around the pyloric stomach. The risk factors of the condition were: age, the use of drugs, cigarettes, alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs), helicobacter pylori infection and associated diseases.

Acute biliary pancreatitis is a common disease for the treatment of which antibiotics and antifungal drugs are used simultaneously. Therefore, this study was performed to examine the effects of (mortality and morbidity rates) fluconazole therapy as an antifungal drug in these patients.
This study was a random clinical trial. Participants were the hospitalized patients who were suffering from acute pancreatitis gallstones and referred to Imam Reza Kermanshah hospital. Participants were randomly assigned to two groups. In one group a conventional treatment (antibiotics) was received and in the other group conventional treatment regimens with fluconazole (200 mg orally on the first day and then 100 mg daily) was added.
87.2 % of the sample were female and 12.8 % were male. The average age of the group receiving fluconazole was 25/16 ± 97/53 and the average age in the control group was 43/16 ± 13/54. The mean duration of hospitalization in patients receiving fluconazole was 10.6 days and 13.6 days for the control group. In the group receiving fluconazole 6/2 % needed surgery and in the control group none. The average length of the stay in the intensive care unit in the control group was 1.28 and in the fluconazole group was 26.1 days.
As the results of this study showed , administration of oral fluconazole had no effects on mortality, need for surgery, cost, length of the stay in hospital and intensive care units .Therefore, because of the complications and costs of fluconazole, it is recommended that all patients with mild biliary pancreatitis should not being treated with fluconazole. This treating method can be used only for those with fungus in their upper digestive system secretions.

laparoscopic cholecystectomy has become a technique of choice for treatment and removal of gallbladder problems. Various studies have been done on its effectiveness & complications. The most common complications are bile duct injuries, bile leakage, wound infection and bile peritonitis. This study retrospectively analysed the total number of laparoscopic cholecystectomy cases performed in Imam Reza hospital (2006-2012). According to the patient''s profile, we tried to determine the actual incidence of complications after L.C. Total of 1380 patients were studied, from whom 1074 cases were female (77.8%). The average age of the participants was 48.11(0/7%). The most common complications were bile duct injuries and bile leakage. The most common location of biliary damage was CBD (61%). Cystic duct injuries and other accessory bile ducts were categorized as following priorities. Incidence of collections after surgery was 15 cases (1.08%). The majority of bile duct injuries were surgically treated (81%), using biliary-enteric anastomosis procedure. The most common and challenging complications of L.C were bile duct injury and bile leakage that occur for patients due to tragic consequences. The most common surgical repair method for bile injuries is biliary-enteric anastomosis and insertion of T.Tube. The alternative method is percutaneous drainage for small leakages.

Despite different methods implemented, surgical wound infection is still an important cause of mortality and morbidity of patients which impose a considerable cost on health care system. According to recent data, administration of supplemental oxygen during operation can reduce the risk of wound infection due to increased tissue oxygenation and therefore better elimination of bacteria by oxidative killing. This study is done to investigate the effect of administered oxygen ratio on the incidence of wound infection in clean-contaminated surgery. This is a double blind clinical trial. 584 patients from both sexes between 18 to 60 years old, who were condidated for clean-contaminated surgery were divided into two equal groups randomly. One recived 80% and the other 40% FIO2 during anesthesia. The frequency of wound infection between the two groups was assessed during a two weeks period. Of patients receiving 80% FIO2, 11 (3.9%) patients, and the group recieving 40% FIO2, 25(8.1%) patients had wound infection (p<0.05). This study similar to previous studies showed the positive effect of supplemental oxygen in decreasing risk of surgical wound infection. Therefore according to the low risk and low cost and effectivness of this method in patients undergone surgery, it is recommended in clean-contaminated surgery.