جستجوی مقالات مرتبط با کلیدواژه « Surgical » در نشریات گروه « پزشکی »

Carotid complications resulting from extra-luminal migration of ingested foreign bodies (FB) are rare but potentially life-threatening. Previous data on the topic predominantly comprises isolated case reports, leaving a gap in comprehensive evidence necessary to guide clinical decision-making. In this article, we offer a narrative review alongside a novel case report, aimed at providing a broad, evidence-based perspective on the topic to guide clinical practice. The search strategy employed keywords related to carotid artery complications from ingested FB across the following electronic databases: PubMed, Scopus, Google Scholar, and Cochrane Central. Screening involved standardized data extraction by two independent reviewers, with a focus on abstracts meeting inclusion criteria and excluding non-English literature and non-relevant studies from further analysis. Moreover, we present a novel case report on the topic that was successfully managed using a unique surgical approach. Overall, a total of sixteen case reports were finally included, data on clinical presentations, diagnostic strategies and findings, surgical management and outcome were extracted, tabulated, and discussed. In carotid complications from extra-luminal migration of ingested FB, high clinical suspicion is crucial due to potentially mild symptoms and negative first-level examinations. Computed tomography (CT) scan plays a pivotal role for accurate diagnosis and surgical planning, along with neck ultrasound to detect complications. Tailored surgical strategies based on the severity of carotid involvement, including venous patch grafts in severe vessels involvement, are crucial for optimal patient outcomes. As a novelty, in our case report, carotid shunt was successfully employed instead of prolonged carotid clamping to reduce the risk of associated neurological sequelae. It could be concluded that, diagnosis and managing carotid complications from extra-luminal migration of ingested FB remains challenging and a multidisciplinary approach is warranted. 

We aimed to assess the most effective route for Tranexamic acid (TXA) administration among Intraarticular (IA), Intravenous (IV), and combined IA/IV for Total Knee Arthroplasty (TKA) surgeries. A double-blinded clinical trial was run on 147 TKA candidates. Blood loss and hemoglobin (Hb) drop were evaluated using the Gross and Nadler formula in three matched case groups administered TXA during the TKA through IV, IA, or combined IA/IV route. Tourniquet was used on all operations for controlling intraoperative blood loss. No drainage catheter was used for the cases.  The combined group showed an average blood loss of 630±252 ml, which was significantly lower than that in the IV group (878±268 ml, P<0.01) and the IA group (774±288 ml, P=0.03). Furthermore, the mean Hb and hematocrit drop were significantly lower in the combined group, compared to the other two groups, 48 and 72 h postoperatively (P<0.05). The combined IA/IV route had a 28% and 19% reduction of blood loss, compared to the IV or IA methods, respectively. Therefore, using TXA via the combined IA/IV route may be more effective for reducing perioperative blood loss following TKA surgery using a tourniquet without drain placement. Level of evidence: I

The treatment choice in the management of odontogenic cysts in the mixed dentition period depends upon the size, location of the cyst, the bone integrity of the cystic wall, and its proximity to vital structures. Enucleation is indicated with smaller cysts, achieved by careful removal of a complete cyst without rupturing the cystic lining. Marsupializationand decompression are the treatments of choice for larger cysts as it can help to preserve the tooth bud of the successor tooth and reduce morbidity. Marsupialization is achieved by opening and deroofing the cyst, and making the cystic lining continuous with the oral cavity or surrounding structures by suturing the edges of the incised mucosa to the cystic wall. This helps in maintaining the patency of the cystic lesion. In the decompression, a cylindrical device (drain) is placed in the lesion, which maintains communication between oral cavity to cystic lesion. This decreases the intracystic pressure and results in bone formation. We present two cases of odontogenic cyst in children, where we used a modified decompression technique. We developed a modified surgical stent with the use of a Hawley’s appliance, which led to cystic decompression, and eventual eruption of the successor tooth. Notably, this modified technique also reduced both patient discomfort and the number of clinical visits, making it an effective treatment option. The unique design of the appliance also acted as a space maintainer for the eruption of successor tooth, which is very critical in mixed dentition for future prevention of space loss and eventual malocclusion. The advantage of our design was its easy removal and insertion with minimal discomfort.

To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primaryimaging tool in trauma patients. We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had atherapeutic intervention from January 2015 to February 2021. Patients’ characteristics, initial chest x-rays, andcomputed tomography (CT) scan were extracted and re-evaluated. Eighteen patients matched the criteria of our research. The mean age and the injury severity score(ISS) was 29.8±11.2 and 38.4±14.4, respectively. Seven patients (38.9%) underwent thoracic endovascularaortic repair (TEVAR), and 11 (61.1%) had open surgery. The TEVAR group had significantly lower meanintensive care unit stay days (6.6±3.9 vs. 10.8±6.9 in open aortic repair (OAR), p<0.05). The percentile ofpatients requiring blood transfusion was significantly lower in the TEVAR group (57% vs. 100% in OAR,p<0.05). Mediastinal widening (66.7%) was the most common finding during the evaluation of initial chestx-rays. Interestingly, 22.2% of the initial x-rays were not remarkable for BTAI. TEVAR is an advantageous choice in the management of BTAI. However, open aortic repair is theoptimal decision in certain situations. It is suggested that the Interventional management of the BTAI must beperformed by experienced vascular surgeons in a medical center capable of both OAR and TEVAR.

Early decompression within the first 24 hours after spinal cord injury (SCI) is proposed in currentguidelines. However, the possible benefits of earlier decompression are unclear. Thus, the present meta-analysisaims to investigate the existing evidence regarding the efficacy of ultra-early decompression surgery (within 12hours after SCI) in improving patients’ neurological status.

A search was performed in Medline, Em-base, Scopus and Web of Science electronic databases, until the end of August 2021. Cohort studies and clinicaltrials were included in the present study. Exclusion criteria were absence of an early or late surgery group, fail-ure to report neurological status based on the American spinal injury association impairment scale (AIS) grade,failure to perform the surgery within the first 12 hours after SCI, and duplicate reports and review articles. Twoindependent reviewers performed data collection, and risk of bias and certainty of evidence assessments. Theoutcome was reported as odds ratio (OR) and 95% confidence interval (CI).

Data from 16 articles, whichstudied 868 patients, were included. Compared to early or late decompression surgery, ultra-early decompres-sion surgery significantly improves patients’ neurological status (OR = 2.25; 95% CI: 1.41 to 3.58). However,ultra-early surgery in thoracolumbar injuries is not significantly more effective than early to late surgery. More-over, ultra-early surgery in patients with a baseline AIS A increases the chance of neurologic resolvent up to 3.86folds (OR=3.86; 95% CI: 1.50 to 9.91). Contrastingly, ultra-early surgery does not result in significant improve-ment compared to early to late surgery in patients with AIS B (OR = 1.32; 95% CI: 0.51 to 3.45), AIS C (OR = 1.83;95% CI: 0.72 to 4.64), and AIS D (OR = 0.99; 95% CI: 0.31 to 3.17).

Current guidelines emphasizethat spinal decompression should be performed within 24 hours after SCI, regardless of injury severity and loca-tion. However, results of the present study demonstrated that certain considerations may be taken into accountwhen performing decompression surgery: 1) in patients with AIS A injury, decompression surgery should beperformed as soon as possible, since its efficacy in neurological improvement is 3.86 folds higher in the first 12hours after injury. 2) ultra-early decompression surgery in patients with cervical injury is more effective than inpatients with thoracic or lumbar injuries. 3) postponing decompression surgery to 24 hours in SCI patients withAIS B to D does not significantly affect the neurological outcome.

Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency depart- ment. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population.

In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complica- tions were compared between the two groups at 3 and 6-month follow-ups.

A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain in- tensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group.

The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.

Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes.

This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over 2 years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments and therapeutic approaches were recorded.

The mean age of neonates was 9.07 ± 8.84 days and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died.  Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR = 12.455, 95%CI: 1.365 – 113.618, P = 0.025).

The most common cause of bilious vomiting was NEC followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation

The Cabrol shunt has been broadly used to control postoperative heamorrhage in aortic surgery since its first description in 1981. The initial description and its modifications aim to divert the blood from within the aneurysm wrap and/or the periaortic space to the venous system. We describe a modification in the context of central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after complex aortic surgery. A query on the PubMed was carried out using such keywords as ‘Cabrol shunt’, ‘Cabrol fistula’, ‘Aorta-atrial shunt’, ‘Perigraft shunt’, ‘Periaortic baffle’, and ‘Left-to-right shunts’. Original articles and case reports in which patients had undergone a Cabrol shunt or a modification to divert aortic bleeding to the venous circulation in the context of aortic surgery were included in the study. All publications were limited to the English language. On the other hand, abstracts and conference presentations, editorials, and correspondence comments were excluded. Finally, 18 articles and case reports were retrieved. A total of 392 cases of Cabrol shunt or a modification have been reported since 1987 with successful control of postoperative bleeding. Long-term results, when available, prove that the addition of a Cabrol shunt does not negatively affect mortality or postoperative complications, rather it decreases re-operation rates, blood transfusion, and hospital stay. Furthermore, the patency of the shunts beyond the immediate postoperative period has been described. The use of a modified Cabrol shunt in the setting of complex aortic surgery can effectively control peri-operative bleeding. Moreover, its application in other complex settings, such as central VA-ECMO, seems satisfactory.

There is few data regarding the correlation between serum Vitamin D level and unfavorable intensive care unit (ICU) outcome in postsurgical patients. In this study, correlation between serum 25(OH)D level and length of ICU stay and in‑hospital mortality has been evaluated in critically ill surgical patients.

Serum 25(OH)D has been evaluated in 70 surgical, critically ill patients. Demographic, laboratory, and clinical data of the patients were collected. Correlation between serum 25(OH) D level and duration of ICU stay and hospital mortality was evaluated using two‑factor analysis of covariance. Multivariable Cox‑regression analysis was used for adjusting the effect of season of blood sampling and type of surgery on the main variables. For all the analyses, P values less than or equal to 0.05 were considered as statistically significant.

Serum 25(OH)D deficiency was identified in 52 (74.3%) of the patients. Patients with serum Vitamin D levels < 30 ng/ml had longer length of ICU stay than those with serum Vitamin D levels ≥ 30 ng/ml (7.8 ± 5.1 vs. 4.05 ± 2.12 days, P = 0.003). Although hospital mortality was more common in Vitamin D deficient patients than sufficient ones (25% in deficient group versus 22.2% in sufficient group), there was no significant difference regarding hospital mortality rate between the groups.

Statistically significant association was found between low 25(OH)D level and increased length of ICU stay in critically ill surgical patients. It could be explained by favorable effects of Vitamin D on immune system functions, reducing tissue dysfunction, and risk of organ failure and overall complications. However, there was no correlation between serum Vitamin D level and patients’ in‑hospital mortality. Further, well‑designed prospective clinical studies with adequate sample size are needed to evaluate correlation between serum Vitamin D level and mortality in critically ill patients.

Surgical site infections are the second most common type of adverse events occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital.

This study was conducted at the general surgery and orthopedic wards of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The medical records of admitted patients who underwent different surgical procedures were reviewed. Compliance was assessed with the recommendations of the American Society of Health‑System Pharmacists’ guidelines for every aspect of antibiotic prophylaxis. All data were coded and analyzed by SPSS16 software using Student’s t‑test and Chi‑square test.

During 1 year, 759 patients who underwent different surgeries were included in the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were in accordance with the American Society of Health System Pharmacists (ASHP) guidelines regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose was lower and in one procedure, it was higher than recommended doses.

Although such guidelines have been in place for many years, studies showed that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines are still major issues. It is essential for surgeons to be aware to consider the best antibiotic choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.

Wounds are physical injuries that cause a disturbance in the normal skin anatomy and function. Also, it has a severe impact on the cost of health care. Wound healing in human and mammalian species is similar and contains a complex and dynamic process consisting of four phases for restoring skin cellular structures and tissue layers. Today, therapeutic approaches using herbal medicine have been considered. Although the benefits of herbal medicine are vast, some medicinal plants have been shown to have wound healing effects in different experimental studies. Therefore, the current review highlights information about the potency of herbal medicine in the experimental surgical skin wound healing. Electronic database such as PubMed, Google Scholar, Scopus, and Medscape were searched for Iranian medicinal plants with healing activity in experimental surgical skin wounds. In this area, some of the most important papers were included. There are numerous Iranian medicinal plants with skin wound healing activity, but clinical application and manufacturing are very low in comparison to the research volume. In normal instances, the human/animal body usually can repair tissue damage precisely and completely; therefore, the utilization of herbs is limited to special conditions or in order to accelerate the healing process.

Otitis media (OM) is a major health problem that usually results from adenoid hypertrophy. The diagnosis is given based on symptoms and imaging studies, such as mouth breathing and lateral neck radiography (LNR), respectively. However, there are huge controversies regarding the LNR role in the management of patients with OM. This study aimed to evaluate adenoid nasopharyngeal ratio (AN ratio) in children suffering from OM with effusion (OME) and related factors. This cross-sectional study was conducted on 27OME-suspected children referring to the Ear, Nose and Throat clinics (ENT) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, in 2016. All the children underwent standard LNRs and indirect laryngoscopy in order to have adenoidal and nasopharyngeal length assessment before surgery. After adenoidectomy, pathologic data were analyzed in SPSS software (version 21) using Pearson correlation, independent sample t-test, and Mann-Whitney U test. The p-value less than 0.05 was considered statistically significant. According to the results, 70.4% of the participants were male. The mean age of the participants was 7.81±2.52 years. All the patients in the study were symptomatic, and the most frequent symptom was mouth breathing (100%). The mean values of AN ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm, respectively. The AN ratio was significantly correlated with laryngoscopic and pathologic adenoid sizes (r=+0.46, P=0.01, and r=+0.44, P=0.02, respectively). The findings indicated a significant correlation between AN ratio and adenoid real measurement. Therefore, researchers are recommended to use this procedure in the assessment of patients with OME due to its availability, inexpensiveness, and negligible sid effects.

BackgroundBleeding is one of the most common complications of craniosynostosis surgery, which its appropriate management is associated with better post-operative outcomes. The aim of this retrospective study was to evaluate the visual estimated blood loss in intraoperative management of infants with craniosynostosis surgery.
Materials and MethodsThis retrospective study was performed on 200 patients who underwent craniocinostosis surgery and hospitalized in intensive care unit (ICU) at Mofid Hospital, Tehran, Iran, from July 2015 to June 2017. Data collecting was done using a self-made checklist and from patient's medical record. Required data include age, gender, method of anesthesia, and arterial blood gas (ABG), hemoglobin (Hb), and platelet (Plt) changes during surgery, volume of administered blood and fluid were recorded and evaluated. Data analysis using SPSS software (version 22.0).
ResultsAmong the patients, 59% (n=118) were boys, the mean age of patients was 13.3 ± 13.52 months. Anesthesia technics were total intravenous anesthesia (TIVA) (15.5%, n= 31), and inhalation or mixed (84.5%, n=169). Patients received 992.02 ± 468 ml fluid and 205.86± 100 ml blood, before surgery.There was no significant difference between preoperative Hb and first Hb in pediatric intensive care unit (PICU) (p=0.12). However, preoperative and first Plt in PICU were different (p=0.000). Also, last Hb in ABG (10.5±1.90), and the first Hb in PICU showed no significant difference (r=0.088, p=0.219).
ConclusionAccording the results, visual assessment and correction of blood loss with hemoglobin measurement and by experienced anesthesiologist was a reliable and safe method in patients with craniosynostosis surgery and feasible in every operating room.

Surgical Site Infection (SSI) is one of the most important complications after spine surgeries. Different methods have been proposed to prevent this type of infection. The present study was performed to evaluate the effect of applying topical vancomycin powder on prevention of SSI in patients undergoing spinal surgery using implants in Al-Zahra Hospital, Isfahan, Iran from February 2015 to June 2016.
Methods and Materials/Patients: In this clinical trial, 100 patients candidate for spinal surgery with implants were divided into two groups using randomization technique including 50 patients in each group. Vancomycin powder solved in 20cc N/S serum was flushed over all layers of the surgical wound in the case group and in the control group sterile normal saline solution was used. Patients were examined at discharge and three months after surgery for ruling out surgical site infection. SSIs following spine surgery can be superficial, characterized by obvious wound drainage and erythema or it can be deep infections disseminating under the fascia which may lead to discitis, epidural abscess, and spondylitis.
One case of SSI was observed in the control group who was 83 years old. The mean age of all patients was 51.9±14.5 years old. The duration of surgery in this patient was 5 hours. The mean duration of surgery was 3.41±0.73 hours. The length of implant, BMI, sex, underlying diseases and other risk factors (diabetes and hypertension) did not affect the rate of infection.
Even though topical antibiotics seem to be effective on controlling SSI but our finding did not support this hypothesis. The authors would like to suggest that keeping routine strict sterility strategies during spine operations is effective enough in preventing surgical site infection.

Despite the vast number of surveys, no consensus has been reached on the optimum timing of spinal decompression surgery. This systematic review and meta-analysis aimed to compare the effects of early and late spinal decompression surgery on neurologic improvement and post-surgical complications in patients with traumatic spinal cord injuries.

Two independent reviewers carried out an extended search in electronic databases. Data of neurological outcome and post-surgery complication were extracted. Finally, pooled relative risk (RR) with a 95% confidence interval (CI) was reported for comparing of efficacy of early and late surgical decompression.

Eventually 22 studies were included. The pooled RR was 0.77 (95% CI: 0.68-0.89) for at least one grade neurological improvement, and 0.84 (95% CI: 0.77-0.92) for at least two grade improvement. Pooled RR for surgical decompression performed within 12 hours after the injury was 0.26 (95% CI: 0.13-0.52; p<0.001), while it was 0.75 (95% CI: 0.63-0.90; p=0.002) when the procedure was performed within 24 hours, and 0.93 (95% CI: 0.76-1.14; p=0.48) when it was carried out in the first 72 hours after the injury. Surgical decompression performed within 24 hours after injury was found to be associated with significantly lower rates of post-surgical complications (RR=0.77; 95% CI: 0.68-0.86; p<0.001).

The findings of this study indicate that early spinal decompression surgery can improve neurologic recovery and is associated with less post-surgical complications. The optimum efficacy is observed when the procedure is performed within 12 hours of the injury.

The information about lower 30-day readmission in Iran is very limited. The current study aimed at evaluating the causes of readmission in an educational hospital based on LACE index..
It was a case-control study evaluating the causes of readmission of the patients from February 2014 till February 2015 (12 months) in a large teaching hospital in Shiraz, Iran. Data were extracted from health information system (HIS) and after removing the planed readmission, the rest of data were examined according to 4 variables of LACE index; in addition to the season of admission, rate of preclinical requests, and patients’ living area. Data were transferred into Stata software version 11.0, according to the conditional regression analysis..
Results showed that 66 patients were readmitted during this time. In addition, having history of chronic non-communicable diseases such as hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD) (here called internal problem) (P = 0.04), surgical procedure (P = 0.03), and rate of paraclinical requests (P = 0.04) associated with readmission..
It is necessary to consider the patients with internal history, surgical procedure, and more paraclinical requirement. In addition, physicians should be educated to give more consideration to these groups.

Child’s hospitalization for surgery is a source of anxiety for the child and the family that persists for a long time after discharge. Therefore, it is necessary to provide appropriate solutions in this regard. This study aimed to investigate the effect of implementation of continuous care model on anxiety in mothers of children discharged from pediatric units of educational hospitals of Isfahan University of Medical Sciences in 2016.
In this quasi‑experimental study, 64 mothers of children hospitalized in surgical units were categorized in two groups (experimental and control). The intervention was a continuous care model including orientation, sensitization, follow up, and evaluation stages. We used Spielberg’s Anxiety Questionnaire to assess mothers’ anxiety before, 1 week, and 1 month after the intervention. Data were analyzed using descriptive statistics, (t‑test and analysis of variance) using the Statistical Package for the Social Sciences version 16.
The results of the study showed that the mean anxiety scores of the experimental group were 58.9, 36, and 31.4, respectively, before, 1 week, and 1 month after the intervention (P Based on the results, use of the continuous care model led to a decrease in mothers’ anxiety during their children’s discharge from the pediatric surgery units. Therefore, we suggest the implementation of this model in pediatric units.