فهرست مطالب

نشریه جراحی ایران
سال سی‌ام شماره 1 (بهار 1401)

تاریخ انتشار: 1401/03/01
تعداد عناوین: 11

فارسی
English

انتخاب همه

Prophylaxis of Venous Thromboembolism in Trauma Patients: The Advance of Experts Based on Available Evidence

bdolrahimzadeh Fard H. MD*, Taheri Akerdi A. MD, Sabetian Fard Jahromi G. MD Moeinvaziri N. MD, Bolandparvaz Sh. MD, Abbasi H. R. MD Homaeifar R. MD, Paydar Sh. MD Pages 1-29

Thrombotic events are accounted as one of the important preventable complications following trauma. Improving the prophylactic protocols is one of the issues that has been considered in recent years. Despite the proven effectiveness of prophylactic protocols in reducing thrombotic events, the increased risk of massive and life-threatening bleeding has limited the widespread use of these protocols.
Theoretically, the administration of anti-thrombotic drugs can lead to extensive bleeding in the affected organ or other organs and subsequently increase the risk of hemorrhagic shock (in solid organ injuries) or the expanding hematoma (in traumatic brain injuries).
Each preventive anti-thrombotic strategy should always address the following considerations in trauma patients:- Assessing the need to start prophylactic anti-thrombotic drugs based on the risk-benefit ratio to prevent vascular thrombosis in trauma patients.

Keywords: Venous Thromboembolism, Prophylaxis, Trauma

Abstract View Paper Research/Original Article Original: Persian
Comparative Study of Anterior versus Posterior Surgical Approaches in Patients with Cervical Spondylotic Myelopathy indicating both Approaches based on Benzel Criteria

Khoshnoudi M. MD, Derakhshanrad N. MD, PhD, Sheikhrezaei A. R. MD Ostadrahimi N. MD****, Saberi H. MD, MPH* Pages 29-43

Introduction & Objective:

Cervical spondylotic myelopathy is a progressive degenerative disease as the most common cause of myelopathic symptoms in elderly patients, and yet many controversies exist regarding the optimal surgical approachs. In lordotic patients with ventral or ventrodorsal compression less than 3 levels, both anterior and posterior approaches can be selected. The purpose of this study was to compare anterior versus posterior surgical approaches in patients with cervical spondylotic myelopathy indicating both approaches based on Benzel criteria for choosing the optimal surgical approach.

Materials & Methods:

This non-randomized clinical trial was performed among patients referred to the neurosurgery clinic of our hospital between 2019 and 2021. Patients enrolled in the study were evaluated for SF-36 (Ware, 1992), mJOA (Benzel, 1991) and Nurick (Nurjck, 1972) scores preoperatively. Then, according to the surgeon's diagnosis, the patients were divided into two groups. It should be noted that all surgeries were performed by one surgical team and after discharge, they underwent 4.5 and 9 months follow-up to re-determine all three scores and the obtained information was analyzed by repeated measures analysis of variance.

Results

In this study, 120 patients with a mean (± standard deviation) age of 61.10 (± 2.41) years, of whom 63 were men (52.5%) and 57 were women (47.5%), were studied. In this study, 60 patients underwent anterior surgery and 60 patients underwent posterior surgery. There was no significant difference between the two groups in terms of age (P = 0.053), gender (P = 0.361), duration of symptomatology (P = 0.075), degree of lordosis (P = 0.052), and anterior- posterior diameters of canal
(P = 0.284). The mean of SF-36 was significantly better in the anterior group than the posterior group at 4.5 (P = 0.001) and 9 months follow-ups (P = 0.001). The mean mJOA was significantly better in the anterior group than in the posterior group at 4.5 (P = 0.002) and 9 months (P = 0.001) follow-ups. The mean score of Nurick before surgery and follow-up of 4.5 months (P = 0.745) and 9 months (P = 0.909) was not significantly different between the two groups.

Conclusions

The results of this study showed that both anterior and posterior approaches improve the condition of patients in follow-up, but in patients with anterior approach, postoperative satisfaction ranking was better.

Keywords: Cervical Spondylosis, Benzel Criteria, Anterior, Posterior, Outcome

Abstract View Paper Research/Original Article Original: Persian
Evaluation of the Relationship between the Duration of Preoperative Pain and the Type of Pathology and Symptoms in Patients Undergoing Laparoscopic Cholecystectomy in Hospitals Affiliated to Babol University of Medical Sciences during 2013-2017

Darzi A. A. MD, Zahedian A. MD, Kamali Ahangar S. BSc, Amirkhanlo N. MD Pages 44-53

Introduction & Objective:

Laparoscopic cholecystectomy is known as the selective treatment of gallbladder disease. This new technique can also cause complications despite its advantages for the patient. The aim of this study was to investigate the relationship between the duration of preoperative pain with the type of pathology and symptoms in patients undergoing laparoscopic cholecystectomy in hospitals affiliated to Babol University of Medical Sciences during 2013-2017.

Materials & Methods:

This is a descriptive-analytical study. From the community of laparoscopic candidates for gallstones caused by gallstones who underwent surgery in the affiliated hospitals of Babol University of Medical Sciences during 2013-2017, 253 patients were selected by convenience sampling method. Demographic information of patients (age group, sex, BMI and education), type of pathology, duration of pain and clinical symptoms before, two weeks and 2 months after surgery were collected in the form of a checklist and data using SPSS 22 software and Kruskal-Wallis, Mann-Whitney and Chi-square tests were examined.

Results

The mean age of the patients was 38.36±14.16 years and the less than 30 years (41.5%), female (78.3%) and overweight (45.1%). The difference between the mean duration of preoperative pain was significant based on the age group (P = 0.02) and the type of pathology (P < 0.001) of the patient; the longest duration of pain was observed in the age group of 31 to 50 years and also in patients with chronic cholecystitis. After grading the duration of pain, the relationship between the duration of pain and the occurrence of classic pain during 2 weeks and 2 months after surgery was significant (P < 0.001), while the relationship with other symptoms of the disease (Sourness, bloating and nausea and vomiting) were not significant (P < 0.05).

Conclusions

According to the results of the present study, the most common complaint of the patient before laparoscopic cholecystectomy was pain, which was significantly reduced after surgery. Also, the duration of pain was longer in the 30-50 of people and in patients with chronic cholecystitis. Also, the duration of pain (graded) was not significantly associated with the symptoms of sourness, bloating, nausea and vomiting, but the presence of longer pain before surgery despite pain during the period of 2 weeks and 2 months after surgery was significantly associated.

Keywords: Cholecystectomy, Pain, Complication, Laparoscopy, Duration

Abstract View Paper Research/Original Article Original: Persian
Evaluation of Sleep Disturbance Factors in Hospitalized Trauma and Non-Trauma Patients in Orthopedic Section of Beheshti Hospital in Babol

Jokar R. MD, Esmaeilnezhad Ganji S. M. MD, Kamali Ahangar S. BScAlavian N. S. MD Pages 54-65

Introduction & Objective:

A good sleep plays an important role in improving the health of patients. Various factors in patients can cause to sleep disorders. Physical illnesses associated with pain can cause sleep disturbance. Therefore, the aim of this study was to evaluate sleep disturbance in patients hospitalized in the orthopedic ward of Shahid Beheshti.

Materials & Methods:

All traumatic and non trauma patients older than 18 years of age admitted to the orthopedic ward of Shahid Beheshti Hospital who had sleep disturbance were included in this
cross-sectional study. Patients were divided into two groups. Data were collected by Pittsburgh standard questionnaire and environmental factors influencing sleep disturbance. Data were analyzed using SPSS software version 16. Chi-square, t-test and Mann-Whitney tests were used. Probability value less than 0.05 was considered significant.

Results

Of 200 patients, 187 patients (93.5%) with traumatized and 13 (6.5%) with non-traumatic events were admitted and hospitalized in the orthopedic ward. 118 patients (59.0%) received opium and 82 patients (41.1%) did not receive opium. Sleep quality in 80 patients (40%) was reported well in the orthopedic unit and sleep quality in 120 patients (60%) was reported poor. There was no significant correlation between the sleep quality in patients with trauma and non-traumatic hospitalized in the orthopedic ward (P = 0.14). In evaluating the sleep quality of patients using opium in the orthopedic section, it showed that 62 (77.5%) patients who used opium, had a good sleep quality, which was reported statistically significant (P < 0.001).

Conclusions

Generally, it can be concluded that the sleep quality of patients hospitalized in the orthopedic ward of Shahid Beheshti Hospital is not acceptable and factors such as the level of education and history of addiction in patients affect their sleep quality.

Keywords: Sleep Quality, Patients, Hospitalization, Orthopedics, Trauma

Abstract View Paper Research/Original Article Original: Persian
Fabrication and Characterization of Polycaprolactone / Polyvinyl Alcohol / Aloe Vera Extract Electrospun Scaffold for Corneal Stromal Tissue Engineering

Mirmohammadi S. M. M.Sc, Ramazani Saadat Abadi A. PhD, Asefnejad A. PhD, Abdollahi A. MD Pages 66-85

Introduction & Objective:

Due to corneal health problems with allograft corneal transplantation, which include a lack of highly quality of donated cornea as well as the rejection by the immune system over a period of five years, corneal reconstruction with the help of new technology is of great importance. In this study, different ratios of polycaprolactone with polyvinyl alcohol containing aloe vera extract were used to prepare an electrospinning scaffold with similar properties to the targeted tissue.

Materials & Methods:

Scanning electron microscopy (SEM) was used to determine the morphology of electrospun scaffolds. In order to determine the physical properties of electrospun scaffolds, their transparency, hy<font>drop</font>hilicity, water absorption and degradability were investigated. The mechanical properties of the scaffolding were also investigated. Fourier transform infrared (FTIR) was used to study the functional groups of scaffolds. To observe the biological properties, the prepared scaffolds were examined.

Results

The results of scanning electron microscopy showed that by addition of aloe vera extract, the diameter of the fibers in the polycaprolactone and polyvinyl alcohol scaffold decreased from 423 to 214 nm. The results of contact angle test, water absorption and degradability showed that with the addition of polyvinyl alcohol and aloe vera extract, the hy<font>drop</font>hilicity and degradability of electrospin scaffolds were increased. The results of light transmission test also showed that with adding the amount of polyvinyl alcohol and aloe vera extract, the light transmission rate of polycaprolactone scaffolding from 14.7% to 74.14% in polycaprolactone and polyvinyl alcohol scaffolds containing aloe vera extract increases. The results of mechanical tests showed that with the addition of polyvinyl alcohol and aloe vera, the Young's modulus of electrospun scaffolds increased compared to polycaprolactone scaffold.

Conclusions

The results showed that the addition of polyvinyl alcohol to polycaprolactone and aloe vera improved adhesion and cellular behavior.

Keywords: Electrospinning, Aligned Fibers, Corneal Stroma, Polycaprolactone, Polyvinyl Alcohol, Aloe Vera Extract

Abstract View Paper Research/Original Article Original: Persian
A Summary Introduction of a Procedure with Excellent Results: Total Knee Replacement

Shafipour R. MD Pages 85-90

Introduction & Objective:

Osteoarthritis, as the most common disease of joints, is one of the more important causes of knee pain and the affected person may be candidate for Total knee Replacement Surgery if no response to conservative treatment is present.

Materials & Methods:

In this article some issues about Total Knee Arthroplasty, including indications, contraindications, techniques and possible complications, are explained.

Results

Nowadays Satisfaction Rate of this procedure is 80-100 percents in different centers and 15 years Survival rate is about 95 percents.

Conclusions

If total knee Replacement Surgery is done according to true indications and based on a correct technique it will solve the problem of most patients suffering a severe Knee Osteoarthitis and will help them to improve their quality of life.

Keywords: Osteoarthritis, DJD, Knee Replacement, Arthroplasty, Knee Pain

Abstract View Paper Case Study Original: Persian
Common Causes of Complaints and Ways to Prevent Medical Malpractice and Good Defense in Surgery

Ghadipasha M. MD*, Ghadipasha P Pages 106-112

Today, despite the efforts of the medical community and the advancement of technology, the number of complaints from the medical staff is increasing. There is an increase in complaints in other countries as well, so we decided to take an effective step in preventing medical malpractice by examining the common causes of complaints, ways to prevent malpractice and good defense in the field of surgery.
Violation is divided into two categories: disciplinary violation; criminal violation. Discipline is in fact a shortcoming in treatment that does not lead to amputation and death. Discipline violations in the medical system. Penalties for disciplinary violations include verbal reprimands or reprimands for permanent deprivation of employment in the medical profession and affiliated throughout the country.
A criminal offense is in fact an act or omission for which a punishment is prescribed by law. A medical malpractice that results in death is a criminal offense, and the penalty for medical malpractice is payment of a ransom, and in cases of death the patient can be imprisoned.
Topics of medical malpractice in surgery counted from the forensic medical commission meetings include:post-abdominal infection infection, complications of obesity surgery, complications of cosmetic surgery on the face, chest and abdomen, failure to diagnose abdominal injuries following trauma, obstruction of the esophagus, incontinence treatment Recurrence of colorectal diseases, postoperative embolism, recurrent nerve damage during thyroid surgery. In the first 9 months of 1400, 8850 cases were examined in the commissions of the Forensic Medicine Organization of the country, which has increased by 11.8% compared to the same period of the previous year. Various disciplines were involved in complaints, of which 5375 were related to different disciplines of surgery, which is 37.6% of the total number of cases and has increased by 10% compared to last year, of which 36% committed negligence compared to last year. There is a 1% decrease. The number of general surgeons involved in the 1999 case was 9.6% of the total number of cases and has increased by 15% compared to the previous year. There are 1260 cases of dentistry, 1226 cases of nursing, 1083 cases of obstetrician and gynecologist, 906 cases of general practitioner, 757 cases of technical manager, 725 cases of
orthopedics.
One of the most important articles that can be Prevention of medical malpractice is helpful Article 158: Committing a behavior that is considered a crime under the law is not punishable in the following cases, and paragraph c states: Any type of surgery or legitimate medicine with the consent of a person or parents or guardians or representatives His legalization and observance of technical and scientific standards and government systems is not considered a crime. In urgent cases, obtaining consent is not necessary. As mentioned in this law, if the other three conditions are met, the punishment will not be considered for the person: a- The surgery is legitimate and has an indication 2- Obtaining consent 3- Observing technical and scientific standards . Of course, all three conditions must be met, and if any of these cases are not met, violations will occur and the medical staff will be punished.

Keywords: Medical Malpractice, Prevention, Defense, Surgery

Abstract View Paper Research/Original Article Original: Persian

علمی مصوب

نشریه جراحی ایران

Iranian Journal of Surgery

فصلنامه پزشکی

آخرین شماره | آرشیو

ISSN: 1735-4099

صاحب امتیاز:

جامعه جراحان ایران

مدیر مسئول:

دکتر ایرج فاضل

سردبیر:

دکتر مصطفی جابرانصاری

تلفن نشریه: ۰۲۱-۲۶۷۵۵۴۱۱

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فهرست مطالب

نشریه جراحی ایران سال سی‌ام شماره 1 (بهار 1401)

نشریه جراحی ایران

Iranian Journal of Surgery

نشریه جراحی ایران
سال سی‌ام شماره 1 (بهار 1401)