محمدحسین سرمست شوشتری

Breast cancer is the second leading cause of cancer deaths and the most common cancer, among women in all over the word. According to the studies, performed in Iran, many of women with breast cancer refer to physician in advanced stages and the time between call to physician and finding of symptoms, is prolonged. We believe, if women in Iran (more specifically Ahvazian women) have knowledge about breast self-examination (BSE) this scenario may not occur. The aim of this study was to assessment the knowledge about BSE among women higher than 18 years in Ahvaz. For this aim, a 14-item questionnaire was distributed among 400 women referring to 10 health care centers in different regions of Ahvaz. The responses were collected and analyzed with SPSS software. The results showed that 32.3 % of participated women had no information about BSE, 41.8% of them had little information, and just 26% of them had acceptable level of information. A significant association was found between knowledge about BSE with age, level of education, and income. However, no association was found between knowledge about BSE with marital status, positive family history of breast cancer and past history of breast diseases. Higher level knowledge about BSE was found among those given education about BSE and those who had regular visits to health care centers.the majority of Ahvazian women had little or no information about BSE and that the screening program in this region is not very succeful. It is hoped that educational programs on BSE and encouragement of women to visit health cenres before the age of 40 may help in early detection and reduce the morbidity and mortality associated with breast cancer.

Introduction & Hemorrhoid is one of the most common anorectal disease which presents with pain, bleeding and mass protrusion from anus. One of the most important reasons to avoid operation in these patients fears of the pain. Pain control specially during the first 24 hour postoperation period results in decreasing urinary retension and constipation as well as increasing patients pleasant. In this study we assisted the effect of pudendal nerve block to reduce pain in posthemorrhoidectomy period and compared with those patients without pudendal nerve block. We randomized 120 patients with average age of 37.7 year who referred to the hospitals of Ahwaz university for hemorrhoidectomy into 2 groups (N1: 60 N2:60). In the first group pudendal nerve block was done but in the second group we didnt. Then pain scores by analogue scale method were calculated in each group at 2, 6, 12& 24 hours after operations. The scores were matched with Chi- Square test. Also we calculated and compared the dosages of injected narcotics. The average pain scores at 2, 6, 12, 24 hours after operation in the first group (with nerve block). Were 2.53, 2.4, 1.91, 2.7, 2.38, and in the second group (without nerve block) were 3.43, 3.23, 2.98, 2.81, 3.11. The average of narcotic dosage in the first group was 0.69 and in the second group was 1.3. P-value in two groups in those times were 0.001, 0.002, 0.001, 0.66. P-value for comparison of two groups was 0.01. P-value for comparison of narcotic consumption was 0.003 In this study, we showed that pudendal nerve block in post hemorrhoidectomy period, reduced pain significantly and decreased narcotic consumption as well.

One of the most common symptoms of the women referring with breast problems is detection of a palpable mass. These masses are benign or malignant. Benign masses are often common in the reproductive age. In this study we try to evaluate prevalence of breast mass with regarding of age and the type of breast mass. In this retrospective study which was carried out over 9 years from 1370 to 1378 (1991 to 1999), was based on histopathological reports of biopsy samples in Imam hospital of Ahwaz. From a total of 787 biopsy reports on breast tissue, 29 % were fibrocystic, and 24.5% were fibroadenoma. Thirty percent of biopsies were from patients in the 3rd decade while 23% of the samples were taken from patients in the 4th decade of life. In the age group lower than 30 years, 95% of the masses were benign, while 100 % of these masses were malignant in the age group above 80 years old women. The most common histopathological type was invasive ductal carcinoma (71.7 %). Benign breast mass is seen in a period of life in a lot of women. The majority of breast masses in females was seen in reproductive ages and the incidence of malignant masses increases with age. The results of this study showed that although the commonest masses in females in the 3rd and 4th decade of life were fibroadenoma and fibrocystic but the percentage of malignancies were significantly higher than reported globally. We therefore, advise early screening and more careful physical exam of young woman at lower age than is practiced in western countries.

Acute appendicitis is one of the most common acute surgical interventions. The base of treatment is surgery but, preoperative and postoperative steps have important role in its outcome. The usefulness of administration of prophylactic antibiotic in acute appendicitis and antibiotic treatment in gangrenous appendicitis and peritonitis has been proved but antibiotic treatment in the first 24h after appendectomy in supurative appendicitis is not clearly defined. Therefore, the aim in this study we try address this problem. In this prospective and blind clinical trial study which was carried out over three years (1379 to 1382) in three educational hospitals affiliated to Ahwaz Jundishapur University of Medical Sciences, on all the cases of supurative appendicitis. In this study 200 patient were divided in two equal groups. The first group was treated with prophylactic antibiotic (cefazolin and metronidazole) in addition to cefazolin and metronidazol 24 h after surgery while the second group only received prophylactic antibiotic treatment. Both groups of patients were followed up for two months and compared for wound infection, post –operative fever, abdominal and pelvic abscess, wound dehiscence and duration of hospitalization. The mean age in was 18.5 y (range 15-40 y) and there was male (56 %). The results showed that there were no significant differences between the selected groups in relation to the rate of wound infection, post-operative fever, and duration of hospitalization which, in group 1 and 2, respectively, were 4 and 6 %, 6 and 8 % and 2.6 and 2.8 days. In addition, there were no cases of abdominal and pelvic abscess and wound dehiscence in either group of patients. The findings from this study show that post-operative antibiotic treatment has no clinical value in reducing the incidence of wound infection, post operative fever, and on the duration of hospitalization. In patients who undergo appendectomy for acute supurative appendicitis.

Prophylactic anti-biotherapy in acute appendicitis is necessary to prevent peritonitis and gangrene of appendix. But anti-biotherapy in the first 24 hours after appendectomy in acute supurative cases requires further investigations. The aim of this study was to evaluate the effect of anti-biotherapy on prevention of the complications of the surgery and duration of hospitalization. This is a prospective blind clinical trial study from 1379 to 1382 in 3 university`s hospitals in AHWAZ including all the cases of supurative appendicitis. In this study 200 patients were divided into two equal groups. In one group cefazolin and metronidazole were prescribed for the purpose of prophylaxis before surgery and in the other group, in addition to prophylactic anti-biotherapy, cefazolin and metronidazol continued for another 24h after surgery. Then the patients were followed up for 2 months to be examined for wound infection, abdominal and pelvic abscesses, wound dehiscence and duration of hospitalization. In this study, 200 patients 56% male and 44% female were divided into two equal groups. Mean age of the patients was 18.5 years (15-40). The first group received antibiotics for 24h after operation. But wound infection and post operative fever were detected in 4% and 6% of these patients respectively and mean days of hospitalization was 2.6 days (2-7 days). In the second group without post operative anti-biotherapy incidence rate of wound infection and post operative fever were 4% and 8% respectively and the mean days of hospitalization was 2.8 days (2-7 days). There were no abdominal or pelvic abscess and wound dehiscence in both groups. In this study incidence of wound infection (p=1.00) and post operative fever (p=0.58) and mean days of hospitalization (p=0.68) were similar in both groups and there were no significant statistical differences. It seems that post operative anti-biotherapy in supurative appendicitis is of no value in reducing the incidence of wound infection, post operative fever and mean number of days of hospitalization.

Splenic cyst is not a common disease. Robbins reported 32 primary splenic cysts from 42327 autopsies examined during 25 years. Splenic cysts are divided into two groups: parasitic and non-parasitic cysts. Splenic cysts are clinically divided to primary and secondary cyst. Ten % of and are primary or true splenic cysts. Because these cysts have non-specific symptoms like vague abdominal pain, abdominal distension and dyspnea, they may become huge by the time of diagnosis. Proliferation of epithelial cell and increased secretion of this cyst layer may be the cause of the growth. The traditional treatment is splenectomy.Subjects and In this case report, a 17-year male old patient with signs of weakness, abdominal distension, and mild dyspnea, which had begun 8 months ago, is presented. On Sonography we found a huge 217x 166 x 301 mm cyst in his spleen. Laparatomy revealed splenic cyst 30x 20x20cm with the same the same pathology. After splenectomy patient was completely cured and left the hospital with a good general condition.

GI bleeding is accompanied with high mortality rate which can be especially massive in the elderly. There are various causes of lower GI bleeding with colorectal source that depends on the age of the patient, colorectal cancer, polyps, infections, diverticulosis and vascular ectasis are common causes. In this study we report the epidemiologic pattern of rectorrhagia with colorectal causes with regarding to age, and sexes and etiology among patients who were admitted, due to GI bleeding, to our hospital over five years in our patients.Subjects and This is a retrospective and cognitive study from 1379 to 1383 over 5 years. This study was evaluated 100 patients that referred to surgery ward of Imam Khomeini hospital with chief complain of rectorrhagia due to colorectal source and we evaluated the incidence in relation to age, sex and causes of bleeding. In this study 62% patients were male. The maximum incidence was in sixth decade of life. The most common cause was amebiasis (32%) and second most common cause was cancer of rectum (23%) and then polyps (22%). The most common age for colorectal cancer was in the fifth and sixth decade of life and most common age of patient with polyps was first decade of life. Amebiasis was more common in the 2nd and 4th decade of life. In this study there was no patient with vascular angiodysplasia. Rectorrhagia with colorectal source must be considered in relation to the age of the patient. In childhood age, the most common cause is polyp and in adolescents and young adult amebiasis and colorectal cancer and then diverticaulitis are more common causes. In our patients there was lower incidence of IBD and diverticulitis than West Country. In elderly patients, malignancy are common causes in elderly patients.

Pilonidal sinus is a common disease with risk of infection in young adults, which occurs in the natal cleft and is common in hairy and fatty males. Treatment often requires surgical intervention. Current surgical method entails wide tissue excision that causes various morbidities such as long time rest. This study was conducted prospectively on 35 patients (test group) who were treated with the conservative surgical resection in Ahwaz Imam Khomeini Hospital in 1374-1375. The results were compared with 24 patients who were used as control group and treated with conventional wide resection method. Eighteen patients from the test group and fourteen patients from the control group were followed-up for 20 ± 4 months. Both groups were nearly similar for age, sex, occupation and body types (hairy, fatty). The results revealed that the mean hospitalization time for control group was 2 day, this was 1.27 days for the conservative group. Furthermore, need for resting and administration of analgesics were significantly different between the groups (P<0.0). Need for resting was 12.5 days in the control group which was significantly lower in the in the conservative group of 8.33 days. Analgesics were required for two days in the control group compared to one day in the conservative group. Wound infection was 11% in the conservative group compared to 14 % in the control group, and recurrence was 5% in test group and none in the in control group. Patient’s satisfaction in relation to scar formation was 88% and in the control group and 85% in test group. In conclusion, it seems that the conservative resection method for pilonidal sinus is a suitable method that results in less hospitalization time, decreased postoperative pain, and decreased resting time, but without any obvious difference in scar and cosmetic change at the site of operation.

Acute inflammation is the most common pathologic change in appendix and it has a well-recognized clinical presentation. However, in some patients, definite diagnosis and treatment may be delayed due to the atypical clinical course of the disease. Patients may present with chronic pain alone or chronic with acute attack of abdominal pain in right lower quadrant with or without other gastrointestinal symptoms. Chronic appendicitis may be a cause of chronic right lower quadrant (RLQ) abdominal pain and its prevalence has been a debated between surgeons and pathologists. This study was retrospectively performed on 1152 appendix specimens obtained following appendectomy due to acute appendicitis, in Ahwaz Imam Khomeini Hospital between 1998-2000. We evaluated the presence of pathological changes associated with chronic inflammation in the samples. We found that acute appendicitis was more prevalent in men (754 cases and 65.5%) than in women (398 cases and 34.5%). Pathologically 162 (14%) of cases had normal appendix, 30 (2.6%) were in early phase, 844 (73.3%) were in suppurative phase of appendicitis. On the other hand, 67 (5.8%), 32(2.8%), 17(1.5%) of cases were in gangrenous, perforation and chronic phases of appendicitis respectively.We concluded that although the chronic inflammation is less common pathologic change of appendix but this may explain some cases of chronic abdominal pain in right lower quadrant.

Inguinal henia is a common disease, which can be repaired with several methods. One of the most important postoperative complications is recurrence, which varies in incidence according to the type of operation.This study was performed prospectively among 60 patients with inguinal hernia in Ahwaz Imam Khomeini Hospital between 1376- 1379. The patients were randomly divided in two groups and hernia was repaired with either tissue or prosthetic method. Follow-up was done for 6-30 months. The mean duration of the follow-up for both groups was approximately 17 months and recurrence occurred only in two patients from the tissue repair group and none of the patients in both groups had wound infection. The results showed that right-sided indirect inguinal hernia was the most common type and mainly occurred in 50 to 80 year old malesIn conclusion, repair of inguinal hernia with prosthetic material (mesh) is a more appropriate method with low incidence of recurrence, without increased incidence of complications and useful in either primary or recurrent hernia.