فهرست مطالب مهدی اسکندرلو

Burn is one of the most common events in childhood. Pain relief in burn patients helps to stabilize the patientchr('39')s hemodynamic parameters. This study aimed to investigate the effect of visual aberration on dressing replacement pain in children aged 6-12 years.

In this one-blind clinical trial with a control group, 80 children aged 6-12 years admitted to the burn ward of Besat Hospital in Hamadan were selected by Available sampling method and then randomly divided into two groups of control and visual aberration. Data were collected using a demographic profile checklist and Usher pain tool. In the visual distraction group, a cartoon of a cat and mouse was broadcast from two minutes before the end of the dressing. In both groups, pain intensity was measured and recorded 10 minutes before dressing, at intervals of two minutes during dressing, and 5 minutes after dressing. Data were analyzed using SPSS 16 software and one-way analysis of variance and analysis of variance with repeated measures.

The results showed that no significant differences were found in the demographic characteristics of children and parents between the two groups of visual distraction and control (P˃0.05). The mean scores of pain intensity at all measurement times between the two groups of visual distraction and The control had a statistically significant difference and in general, the pain intensity score in children in the visual distraction group was lower than the control group (P <0.001).

In general, the results showed that the visual distraction method is effective in reducing the severity of burn pain in children.

Splenectomy is one of the most common abdominal surgeries following internal and hematologic diseases, as well as trauma which is along with some complications. This study aimed to investigate the effects and outcomes of drain placement after splenectomy, open splenorrhaphy, or laparoscopy.

This descriptive cross-sectional study included patients with various indications who underwent splenectomy with midline or left subcostal incisions in Besat Hospital, Hamadan, Iran, during 2017-2018. It should be noted that the patients underwent drain insertion, and the final outcomes were evaluated after surgery. Regarding the aim of the study, variables, such as hospital stay duration, postoperative infection, the incidence of collection and dehiscence, the duplication of surgical procedures, and secretion levels on days 1 to 5 post-operation were assessed using checklists and clinical examinations. All data were analyzed using SPSS software (version 21.0). A P-value less than 0.05 was considered statistically significant.

According to the results, the mean age of the patients was 42.12±20.26 years. Moreover, out of 31 patients under study, 21 cases were male. In total, 16 (51.6%) and 15 (48.4%) patients underwent splenectomy using subcostal and midline incisions, respectively. The indications for surgery in patients included idiopathic thrombocytopenic purpura (n=10, 32.3%), hemolytic anemia (n=2, 6.45%), trauma (n=7, 22.6%), spleen mass (n=2, 6.5%), diagnostic procedure (n=3, 9.7%), splenomegaly (n=5, 16.1%), and hematological problems along with biliary stone disease (n=2, 6.45%). Regarding the surgical complications, the wound site collection (n=6, 6.45%) and left sub-diaphragmatic and Morison's pouch collection (n=6, 19.35%) were reported in this study. It should be noted that the duplication of the surgery was performed only in one patient, and all the cases had drainage secretions until the third day.

The insertion of the drain after splenectomy not only prevents complications, such as hematoma, seroma, or pancreatic secretion collection below the left diaphragm but also informs the surgeon, in some cases, about bleeding after surgery. Therefore, it seems that the benefits of drain placement may outweigh the risks of not using it.

Penetrating trauma to anterior neck can induce cerebral ischemia due to carotid artery injury. Brain ischemia also can present after surgical carotid repairs. Early diagnosis and suitable treatment modality prevent from permanent neurologic deficit post operatively.Case Report: A 30 years old man with stab wound to zone two left side of neck underwent exploration and penrose insertion. Due to excessive bleeding through drain tube, patient was transferred to Besat Hospital of Hamadan. Surgical repair of external carotid artery successfully was done. Four days later patient developed right hemiparesis suddenly. According to MRI and color Doppler sonography finding of thrombosis of left common and internal carotid artery, reoperation was done. After thrombectomy cerebral ischemia and hemi-paralysis improved. Surgical approach to symptomatic penetrating neck trauma is oblique cervical incision, control of bleeding, repair of internal carotid, repair or ligature of external carotid artery base on some factors and preferential repair of internal jugular vein. Meticulous and fine surgical technique for both vascular repair and protection of adjacent normal vessels for avoiding to blunt trauma or compression with retractors is noticeable. Exact postoperative care as repeated clinical examination with goal of early diagnosis of internal carotid artery thrombosis and rapid diagnostic and treatment planning of this complication are important factors for taking of good result in treatment of penetrating trauma to carotid.

Introduction & It is believed that the appendix location changes with the growing of uterus during pregnancy. Therefore، it is expected that pregnant patients with acute appendicitis، pain and tenderness shif to the superolateral part of abdominal cavity. This can affect both the diagnostic and surgical approach to the acute appendicitis of these patients. A descriptive study was carried out over 240 pregnant women. During laparotomy and cesarean section anatomical position of the appendix was evaluated with respect to the Mcburney point and incision. The patients were grouped into A (full term with gestational age > 37 weeks) and B (preterm with gestational age 20-37 weeks). Also anatomical location of the appendix evaluated in 50 other men and non pregnant women as control group. Comparison of anatomical location of the appendix and cecum in 240 studied patients in their respect to the 50 patients in the control group revealed no significant statistical difference with chi square test. In 188 (78. 3%) patients the appendix was located in the limit of Mcburney point and incision. In 52 patients (21. 7%) the anatomical location of the appendix had been changed to Subheptic space (28 Case) and right flank (24 cases). In 46 patients، the location of the cecum was at subheptic and right flank. Gross change of the appendix position toward the upper and lateral part of the peritoneal cavity was seen only in 6 patients. No statistical analysis difference was seen on the change of appendix location between 223 full term and 17 preterm pregnant patients relative to the 50 patients of the control group. Usually، the anatomical position of the appendix does not change with the growing of uterus during pregnancy. Therefore، Mcburney point and right lower quadrant is the landmark location in simple acute appendicitis for both clinical diagnosis and surgical approach.

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 & Trauma is the most common cause of death in the first three decades of life. An Important way to decrease mortality rate in traumatic patients is the quick diagnosis of organic injuries. Abdominal paracentesis and diagnostic peritoneal lavage are effective techniques for rapid diagnosis of primary injury، before the appearance of clinical signs and symptoms. This study aimed to analyze the diagnostic value of needle aspiration of abdomen with open peritoneal lavage in the patients with abdominal trauma. This study was a randomized clinical trial on 55 patients with abdominal trauma who were admitted to hospital، and had indications of DPL and TAP، without any contraindications of DPL. All patients first tolerated TAP and then DPL and we compared the results through surgical findings. Data from questionnaire was processed with، SPSS version 16، and were presented with tables and descriptive statistics. Fifty five patients with multiple traumas were studied. Forty seven of them were male with ages between of 70 to 76 years old. In five patients، intra abdominal hemorrhage was reported in the diagnostic TAP، consistent with surgical findings. In 47 patients، TAP was negative، but DPL was positive and consistent with surgical findings. In 2 patients، DPL and TAP were apparently negative، but microscopic examination of DPL was consistent with surgical findings. Sensitivity and specificity of diagnostic TAP in this study were 9. 25% and 100% respectively، with negative predictive value of 2%. In patients with multiple traumas suspected for intra abdominal injuries، diagnostic TAP is not reliable and is not recommended. Open Peritoneal Lavage is a fast، safe، and reliable method for diagnosis of injured viscus in patients with various trauma and abdominal trauma.

Introduction & Surgical therapy is still useful and preferred for patients with large third-degree or fourth-degree hemorrhoids. One of the novel methods in the surgical treatment of hemorrhoid is laser therapy. The aim of this study is to evaluate the outcome of closed hemorrhoidectomy versus laser therapy. In this study, 56 patients with internal hemorrhoids of grade III, who were admitted to the hospital, were divided randomly into two groups, each one containing 28 patients. The first group were treated by using laser hemorrhoidectomy and the other group underwent the Ferguson closed hemorrhoidectomy. Visual pain score and complications such as bleeding, urine retention, anal stricture, gas and fecal incontinence and infection were compared in the two groups. The data in questionnaire and forms were analyzed with SPSS software and descriptive statistics and if needed statistical tests of T-test and chi- square test was done, and if needed accurate Fisher test was used. A P-value of less than 0.05 was considered as statistical significance level. There was no significant difference between age and sex in the two groups. Visual pain score in laser hemorrhoidectomy in the first 24 hours (1.42 ± 1.57) and during the first week (0.49 ± 0.39) was significantly less than the case of closed hemorrhoidectomy group (respectively 1.91 ± 2.57 and 0.58 ± 0.75). Except in the cases of bleeding, which was considered to be significantly lower in laser therapy than control group, the difference between the two groups was not significant as far as other complications is concerned. The two groups did not differ in duration of surgery. However, the cost of laser hemorrhoidectomy group was significantly higher (P< 0.001). Despite higher costs, laser treated hemorrhoidectomy patients experienced less pain than the standard hemorrhoidectomy patients. So, we suggested laser therapy as the preferable method in treating hemorrhids.

Presence of foreign bodies in the anal canal and rectum is usually due to introducing of objects. Various clinical presentation and lack of tendency for giving a definable history are important which may cause delayed and misdiagnosis of disease.In this study the case of a 35 years old man with 10 days history of abdominal distention and pain admitted to hospital is reported. The patient underwent laparotomy because of clinical findings in favor of peritonitis. We found that rectal perforation was due to presence of an orange in the anal canal. Anal canal foreign bodies cause different and unusual clinical presentation. Therefore good clinical and especially rectal examination is advised for early diagnosis and treatment.

Nowadays penetrating cardiac trauma has increased and is one of the important causes of mortality in patients with sharp chest trauma. Frequently death occurs in prehospital era. Routine approach for diagnosis of those patients who are referred alive to the hospital are clinical and paraclinical findings so due to take a long time, they can be life threatening. With early diagnosis and treatment, improvement up to 70 – 80% is predicted.Case Report: In this report 4 patients with stab wound to the chest and heart are presented that were referred to Mobasher hospital in 2005 and 2006. There seen several non specific signs and symptoms suggestive to cardiac injury in two and clinical presentation were infavor to cardiac injury in another ones. With careful clinical examination specially about anatomical location of the chest penetrating trauma and evaluation of tract of sharp object in the chest wall and proximity to the heart, early surgical exploration through minithoracotomy was done and they treated after diagnosis of cardiac rupture. It seems in patients with penetrating chest trauma, if finger examination of tract of the wound revealed direct penetration to the pleural cavity and had proximity to the heart, there is no need further work up and in clinically unstable patient, exploratory anterior minithracotomy through intercostal space 4th or 5th and in stable patient, thoracoscopy or minithoracotomy is recommended.

This study was conducted to evaluate the clinical and reproductive outcomes after Laparoscopic Ovarian Drilling (LOD) performance in infertile women with Clomiphene resistant Poly Cystic Ovary Syndrome (PCOS). Regular menstrual cycles, ovulation and pregnancy rates have been considered as three main outcomes being evaluated in this study. 72 Clomiphene-resistant anovulatory women with PCOS in Karaj Hospital were taken into account in this study from 2002-2005. Laparoscopic Ovarian Drilling (LOD) using a needle cautery was performed. Each ovary was punctured at 6 points. Patients were followed for 24 months for evaluating the outcome. After laparoscopy, regular menstruation occurred spontaneously in 82.6% and maintained regular at least for 6 months. The incidence of conception at 6, 12, 18, and 24 months after surgery was % 14.7, %36.8, %58.5, %67.6 respectively. Laparoscopic ovarian drilling is an effective treatment in Clomiphene-resistant anovulatory women with PCOS.