فهرست مطالب mahdi alemrajabi

The standard surgical treatment for low rectal cancer is abdominoperineal resection (APR). Comparing to primary closure, immediate flap reconstruction has shown to have good outcomes. We aimed to assess the inferior rectus abdominis muscle flap complications after APR surgery, a new method of reconstruction.

This study was conducted from 2014 to 2016 in a single center in Firoozgar Hospital, Tehran, Iran. Eighteen patients who underwent pelvic floor closure with inferior part of abdominis rectus musculofascial flap were included enrolled. The sampling method used in this study was census. All patients had distal rectoanal malignancies. A checklist including age, gender, tumor location, complications after surgery, tumor type, length of hospital stay, length of operation, neoadjuvant chemotherapy and neoadjuvant radiotherapy history was filled for all patients.

Among 18 participants, 27.8% were female. The mean age of participants was 58.28 ± 17.86 yr (minimum of 19 and the maximum of 89 yr). The pathology of the tumor in all but one of the cases was adenocarcinoma (94.4%). The overall complication rate after surgery was 27.8%. In total, 80% received neoadjuvant chemoradiotherapy. In a one year follow-up, 16.8% of patients died.

Inferior part of rectus abdominis muscle flap was a reliable and comparable means of reconstruction after APR surgery with low rate of complications and mortality.

Constipation is one of the most common gastrointestinal discomforts that affects various age groups in humans. Different mechanical cleansing devices have been introduced yet. However, they are very expensive and not available in our country.

This was a pilot experimental trial. Fifteen patients with eligible ROME III criteria and at least two years of chronic constipation and resistant to medical therapy entered the study. Wexner and Longochr('39')s scores were checked before and after using the “Roodeshur” device. Data entered SPSS 16 and analyzed using T-test. A p value below 0.05 was considered as a statistically significant difference.

Five patients were female and 10 males. The mean age of patients was 53.56±18.34 years. There was a significant difference regarding intestinal movement before and after using the device (p˂0.001). Wexnerchr('39')s score decreased after the intervention with a significant difference (p˂0.001).

Our mechanical cleansing device (Roodeshur) was effective and safe for patients with resistance constipation. No complication occurred. Due to its low cost and easy access in our country, it can be recommended for other patients as well. However, more studies with a larger sample size are recommended.

Lower gastrointestinal cancer patients like other immunosuppressed patients are vulnerable to develop more severe infections. Iran is one of the countries with high incidence of COVID-19 and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted if a patient with rectal cancer presents with obstructive symptoms and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient will undergo open surgery considering patient's health and protection tips.

Colorectal Cancer (CRC) is the third most common cancer after prostate (breast in women) and lung cancer; it is also the third cause of cancer deaths reported in both men and women in 2020. Currently, the most commonly used diagnostic tools for CRC are colonoscopy, serological methods, and other imaging techniques. Despite the benefits and abilities of these methods, each of them has disadvantages that reduce its functionality and acceptance. The aim of this study was identifying specific and non-invasive genetic biomarkers to diagnose colorectal cancer.

In this study, changes in the expression of HLTF and SEPT9 genes were evaluated by Real Time PCR in blood and tissue samples of CRC patients. A total of 100 samples (50 Blood and 50 Tissue samples) were evaluated with a definite diagnosis of CRC in Firoozgar Hspital, Tehran, Iran, in 2018. The QPCR method was used to compare the expression of candidate genes between the patients group and control group in both samples. Sensitivity and specificity of the test were examined using ROC curve analysis.

The results showed a significant down-regulation in the expression of both selected genes in tissue and peripheral blood in the various stages of the CRC. The sensitivity and specifity of both genes was about 80%.

The findings showed that the two candidate genes can be suggested as specific biomarkers for diagnosis of CRC using the peripheral blood as a non-invasive method. For a definite conclusion, more research is needed.

Obesity is considered as an independent risk factor for type 2 diabetes (T2D) and other metabolic diseases. Obesity accounts for about 55% of diabetes. This study aimed to investigate the therapeutic effects of obesity surgery on glucose, HbA1C, insulin and C-peptide serum levels in the patients with T2D.

Methods and materials: 

This prospective cohort study carried out on 25 patients aged between 18-70 years who had with T2D and body mass index above 40 kg /m2. Fasting blood sugar (FBS) level, HbA1C and Two-hour postprandial (2HPP), insulin level, and C-peptide were measured in all patients before surgery and the patients were fully evaluated for the presence of diabetes complications. The patients underwent Roux-en-Y Gastric Bypass (RYGB), mini-gastric bypass, and sleeve gastrectomy, and were re-evaluated 24 hours, one week, two month, and six months after surgery.

Twenty-five people underwent (sleeve gastrectomy for 12 cases, RYGB for 7 cases and mini-bypass surgery for 6 cases). Twenty cases (80.0%) were women and five cases (20.0%) were men. The mean age of the patients was 46.16 ± 10.97 years (25-67 years).The mean fasting blood sugar, 2HPP, HbA1C, insulin, and C-peptide in general and in all three groups showed a significant decrease.

The findings of the study showed that all three surgical procedures were effective in improving T2D by six months after surgery.

Local anesthetics have been proven as a method to reduce postoperative pain and opioid use. It reduces side effects associated with drug use and may improve patient health and reduce hospital length of stay. The aim of this study was to evaluate the effect of intraperitoneal bupivacaine on post-operative pain in laparoscopic colorectal surgery.
In this prospective randomized control trial, 63 patients aged 20-70 years candidates for laparoscopic proctectomy or rectopexy surgery, were divided into two groups. In the case group, anastomosis site was washed with 50 mL of bupivacaine 0.2% intraperitoneally. In the control group, equal volume of normal saline was used as placebo. Intravenous autofuser pain control filled with 3 g paracetamol was considered for all patients. Visual analogue scale (VAS) was recorded at 2, 8, 24 hours and narcotic usage was recorded totally for the first 24 hours after the operation.
There was no significant difference between pain scores according to the VAS criteria at 2, 8, and 24 hours after the operation in the case and control groups (P>0.05). Total pethidine consumption during the first 24 hours after the operation was lower in the bupivacaine group (49.03 ± 45.77) compared to the control group (77.74 ± 63.50), but the difference was not significant (P>0.05). However, the total dose of pethidine used after 24 hours after proctectomy (not rectopexy) was significantly lower in the bupivacaine group than that in the control group (P<0.05).
Intraperitoneal lavage with bupivacaine during the operation reduced post-operative total narcotics use in patients who underwent laparoscopic proctectomy, not in rectopexy.

The emotion thermometers (ET) is one of the main tools that is recommended, but it has not been examined in Iran. The aim of this research was to evaluate the psychometric characteristics of the Persian form of ET in advanced cancer patients. In this cross sectional study, 150 advanced cancer patients, who were referred to palliative care at Firoozgar Hospital from September to November 2017, were selected through convenience sampling method. Then, the instrument was translated into Persian and back-translated and its content and face validities were examined. To ensure divergent, convergent, and predictive validity, McGill quality of life questionnaire and hospital anxiety and depression scale were used. also, sensitivity and specificity were determined by using the receiver operating characteristics curve. Finally, to assess the reliability, the test-retest correlation was calculated via the Pearson correlation coefficient. The data were analyzed by SPSS 21 software (P < 0.01). The results of this study provided strong supports, which confirmed the content and face validities. Regarding the convergent and divergent validity, ET had a direct and strong relationship with HADS and all thermometers had a significant and reverse relationship with MQOL. The results of logistic regression showed that the model based on 5 variables of prediction could explain 65% of the variance of hospital anxiety variable and 51% of the variance of hospital depression. Using a cut-off of 3v4 on all thermometers against hospital anxiety, the optimal thermometer was the Anxiety Thermometer (specificity 68%, sensitivity 97%) and against the hospital depression scale, the optimal thermometer was the depression thermometer (specificity 74%, sensitivity 82%). Also, the results showed that the test-retest correlation coefficient varied from 0.81 to 0.88. This study has provided some evidence on the validity and reliability of the Persian form of ET as a sufficiently accurate way for identifying the distress of advanced cancer patients.

Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages.

In this case report, a new method of reconstruction is presented which contains only the inferior part of the rectus abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral inferior part of rectus abdominis muscle flap and patient 2 received a bilateral flap.

Immediate flap reconstruction after APR has fewer complications than primary closure and the inferior part of rectus abdominis muscle flap seems to be a possible means of reconstruction after APR.

This study aims to present the pattern of antibiotics administration in Firoozgar Hospital as an example of how antibiotics are administered in Iranian hospitals. The pattern is compared with the proposed model in the literature and relevant guidelines to determine the extent to which errors are committed in this regard.
In this cross-sectional study, 72 cancer patients were recruited who underwent surgical procedures in Firoozgar hospital in 2014. A survey was made the amount, type, and duration of antibiotics taken by the subjects. Data were analyzed using SPSS software version 16 (SPSS, Chicago, IL, USA). The results for quantitative variables are expressed as mean and standard deviation (mean±SD) and for the qualitative variables are expressed as percentage. The comparison between quantitative variables was performed by ANOVA. The significance level (P-value) is considered to be less than 0.05.
In laparoscopic surgeries, patients on average received 4 days of Ceftriaxone and 3 days of Metronidazole. After Whipple procedure, patients took 8 days of Ceftriaxone and 7 days of Metronidazole and in the open gastrectomy, the mean Metronidazole and Ceftriaxone consumption was 4 days. These numbers increased about 5 days for gastrectomy and if they took esophagostomy, Ceftriaxone for 5 days and Metronidazole for 3 days. The average number of hospitalization in laparoscopic procedures was 6 days; in the Whipple procedure, it was 16 days, and in gastrectomy operations, it was 9 days.
Comparing the long duration of hospital stay with the national protocols and the different antibiotic doses for various surgical procedures, further investigations could be conducted to switch the form of national protocols.

Central venous catheters (CVCs) are increasingly used for central vein pressure measurement, fluid replacement, blood-product transfusion, hemodialysis, and chemotherapy. Considering the urgent nature of placing CVCs in many patients, local anesthesia is used in order to facilitate recovery and prevent the side effects of general anesthesia. The successful placement of CVCs can reduce injury to adjacent structures.

This study aimed to assess the patients’ pain level, satisfaction, and injury to adjacent structures. Patients and

This case series evaluated 213 patients with end-stage renal disease (ESRD) who had been referred for duallumen hemodialysis catheter (large-bore) placement during the year 2011 at Hasheminejad kidney center (Tehran, Iran). Catheters were placed by a single surgeon, and 5 ml of subcutaneous lidocaine 2% was used at the site of catheterization. At the end of the procedure, pain was measured using a visual analog scale, and the patients’ satisfaction was verbally determined with regard to whether they would accept local anesthesia if they required catheter placement again in the future.

Fifteen patients reported that they would prefer general anesthesia for a similar procedure in the future. Five of these patients experienced mild pain with the present procedure, and the remainder had severe pain. The mean pain scores were 1.93 ± 0.799 in patients who preferred general anesthesia and 1.26 ± 0.450 in the remainder. The difference between the two groups was significant. One hundred ninety-eight patients experiencedmild pain during catheter placement, of which 187 (94.4%) would accept local anesthesia for this procedure in the future. Twenty-two (10.3%) patients underwent arterial puncture, 163 had single-attempt venous puncture, and 50 had two or more puncture attempts. In nine patients, the puncture was unsuccessful and the vein could not be found despite three attempts to insert the needle; for these patients, the anatomical area approached for access was changed.

Local anesthesia facilitates quick recovery, is time-saving, and can reduce hospital expenses. It seems to be a suitable method for reducing complications and increasing patient satisfaction.