Academic Journal of Surgery
Volume:6 Issue: 1, Winter 2023

Anastomosis leakage is a pivotal post colorectal surgery, threatening patient survival. Unspecific clinical presentations prolong the diagnostic process, potentially reducing the effectiveness of interventions. This situation has highlighted the need for a biomarker that enables early prediction of anastomosis leakage (AL). Previous studies suggest the potential utility of serum levels of white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT) as biomarkers for early detection of AL. Consequently, the present study was conducted with the aim of investigating the potential correlation of these markers with the occurrence of AL.

Patients who were referred to the hospitals of Tehran University of Medical Sciences from November 2018 to January 2020 were evaluated for inclusion in the study. After obtaining informed consents, 277 cases were enrolled in the study. Serum levels of WBC, CRP, and PCT were measured preoperatively and up to five days postoperation. A statistical correlation analysis was conducted using SPSS software (version 24).

Among the 277 cases, 14 exhibited AL. The highest sensitivity and specificity for AL were observed for CRP on the second and third post-operative days. PCT, however, showed higher utility on the fourth post-operative day with 57% sensitivity, 56% specificity (p-value = 0.001 for the second day and 0.002 on the third day), and a negative predictive value of 96%. These values changed to 36%, 64%, and 95% respectively on the fifth postoperative day, which remains within the acceptable range (p-value = 0.018).

Both CRP and PCT have potential utility as diagnostic biomarkers for the presence of AL and can significantly accelerate the diagnosis period. For the highest sensitivity and specificity, CRP should be used on the second and third post-operative days. The optimal utility for PCT, however, is on the fourth post-operative day.

Maintaining hemostasis is considered a remarkable challenge during total thyroidectomy. The use of thermal ultrasonic electrocoagulation (harmonic scalpel) for total thyroidectomy was recently introduced to substitute the conventional ligation methods. However, controversies exist on the efficacy of this technique compared to the classic method.

The data regarding this prospective cohort study was gathered between March 2019 to March 2020. Ninety participants were enrolled in the study. Forty-five subjects received harmonic scalpel ligation and the other forty-five participants underwent conventional total thyroidectomy. Afterward, these two groups were statistically compared regarding surgical time, postoperative hypocalcemia, drainage volume, postoperative pain, hospital stay, and recurrent nerve damage.

No significant difference was detected in the group undergoing harmonic ligation concerning postoperative pain, postoperative hospital stay, drainage volume, and postoperative hypocalcemia in the first 48 hours post-operation. However, using a harmonic scalpel significantly reduced the surgical time (56 ± 2 minutes in the harmonic scalpel group versus 67 ± 9 in the conventional technique group, p < 0.001). Also, no recurrent nerve damage was detected in the study.

Utilizing a harmonic scalpel has a remarkably higher time efficacy in total thyroidectomy. However, the study suggests no further advantage for this method compared to the conventional techniques in total thyroidectomy.

The aim of the present study was to compare the different outcomes and response rates of talc powder injection via chest tube and talc spray through thoracoscopy in the treatment of malignant pleural effusion in patients.

In this randomized controlled trial, patients with malignant pleural effusion, who were hospitalized in the surgery and hematology-oncology departments of Shariati and Imam Khomeini Hospitals, were enrolled. The patients were randomly divided into two groups: chest tube and pleuroscopy, using simple randomization. The mean and standard deviation, frequency and percentage, independent sample t-tests, chi-square, and Fisher’s exact tests were used for data analysis. A p-value of less than 0.05 was considered statistically significant.

No significant difference was observed between the two groups in the incidences of chest pain, fever, and both symptoms (p > 0.05). The treatment success rates among the chest tube and pleuroscopy cases were 83.3% and 100%, respectively, and there was no significant difference between the two groups (p = 0.05). Among the five patients who had a recurrence, four (80%) had lung cancer, and one (20%) had liver cancer, and this difference was significant (P = 0.003). Regarding the rate of response to the treatment according to the side with effusion, among the people who had a relapse, two people (40%) had right-sided effusion, and three others (60%) had left-sided effusion (P = 0.623).

Both techniques were safe, had minor side effects, were transient, and easy to manage. However, the recurrence of the disease in the thoracoscopic pleurodesis method was significantly less than in the chest tube.

In the treatment of pleural empyema, medical therapy is typically sufficient for the 1st or 2nd stage. However, surgical intervention becomes the optimal modality in the 3rd stage. A significant number of patients experience delayed diagnosis and treatment, leading to the conversion of non-surgical pleural empyema into complicated surgical empyema.

A cross-sectional study was conducted on patients with pleural empyema who were admitted to NRITLD in Tehran from 2015 to 2016. Initially, 66 patients were selected; however, after the exclusion of 12 patients, a total of 54 patients were included in the study.

Delays were attributed to the medical system in 62% of cases and to the patient in 29% of cases. The median (IQR) of the total delay time attributed to the system was 38 (25) days. No significant difference was found in the median of delayed referrals between genders. A significant correlation was observed between the interval of the first and last visit and the interval between the onset of symptoms and chest x-ray (CXR), as well as the interval between the performance of CXR and the insertion of chest tube drainage (CTD).

The delay in referral and treatment can be attributed to the patient, practitioners, or both. In this study, it was found that the medical system is the primary cause of delay, primarily due to the long waiting times for admission and operation in hospitals. Patients who experience a delay in CXR and CTD insertion will face a significant delay in referral and their course of treatment. It is suggested that delayed referral could be prevented by providing patients with basic medical education, offering specialized training to general practitioners for early referral, and managing waiting lists effectively.

Revolutionary developments in the surgical field have led to a comparative reduction in surgeryassociated complications than in the past. However, some complications, which directly indicate surgeon’s negligence, should not be underestimated. Gossypibomas, a rare but horrifying complication of surgeries, occur when cotton foreign bodies are retained in the patient and are only discovered after long periods of time.

A 46-year-old diabetic anemic female, with a previous history of operative management for cancer of the cervix (stage IA2), presented with features suggesting sub-acute intestinal obstruction.

Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed a linear hyper-attenuating string-like structure in the distal bowel loop, suggesting a Retained Foreign Body. The patient was immediately taken up for exploratory laparotomy, and the retained foreign body was removed.

Although the diagnosis of Gossypibomas can be challenging at times, it is imperative to manage patients with this rare complication swiftly and precisely to prevent permanent future disabilities. Young surgeons should be made aware of the legal consequences of such a dreaded complication and should anticipate the diagnosis in bizarre surgical circumstances.

Sigmoid and rectal cancers are common malignancies that necessitate surgical resection as the primary treatment modality. However, surgery can significantly impact the quality of life (QoL) of patients, particularly in terms of bowel function, sexual function, and psychological well-being. This study aimed to compare the QoL of patients who underwent surgery for sigmoid and rectal cancers.

A prospective study was conducted on 90 patients who underwent elective surgery for sigmoid or rectal cancer between January 2019 and December 2021 at the center. The QLQ-C30 and QLQ-CR29 questionnaires were utilized to assess the QoL of patients post-surgery. The QoL scores between the two groups were compared using t-tests and repeated measures ANOVA.

The average age of the patients was years, and 57.8% were females. The sigmoid group comprised 44 patients (48.8%) who underwent sigmoid colectomy, and the rectal group consisted of 46 patients (51.2%) who underwent low anterior resection. There were no significant differences in the baseline characteristics and QLQ-C30 scores between the two groups and also in other categories (sex, age groups, and cancer stages) (p > 0.05). However, a significant difference was observed between the QLQ-CR29 scores of the two surgical groups (p < 0.05). QLQ-CR29 was not significantly different between sex and age groups and cancer stages (p > 0.05).

The study demonstrated that surgery for sigmoid and rectal cancers deteriorated the QoL of patients, irrespective of the type of surgery or the location of the tumor. There was no significant difference in the QoL between the sigmoid and rectal groups measured by QLQ-C30. However, QLQ-CR29 showed significantly better QoL for the rectal group.

The objective of this study was to investigate the relationship between the increase in color Doppler ultrasound indices of the ophthalmic artery and the serum lactate level and the severity of the disease in patients with sepsis.

This was a cross-sectional study conducted on 24 patients diagnosed with sepsis, who were admitted to the intensive care unit of Shariati Hospital. The patients were more than 18 years old, hospitalized in the first 42 hours, and selected by the portable color Doppler ultrasound available in the ICU department. The ESI probe was placed on the patient’s eye with the eyelid closed, and the ophthalmic artery was located. The indices including RI, PSV, PI were measured along with their serum lactate levels. The correlation of these indices with the severity of sepsis was checked.

In this study, 24 patients who were less than 81 years old were diagnosed with sepsis and had a sofa score above 3. It was observed that there is a significant relationship between the dose of increased lactate levels and PSV1, and this parameter can be considered a predictive factor. It was also observed that there is a significant relationship between the dose of increased lactate levels and PSV2, and this parameter can be considered as a predictive factor. Additionally, there is a significant relationship between the dose of increased levels of lactate and PI, and this parameter can be considered as a predictive factor.

The study found a significant relationship between increased levels of lactate and decreased blood supply in the optic artery. It is suggested that due to the lack of numbers in this study, more samples should be investigated in future studies. In a scientific article, the use of “we” and “our” should be avoided. If necessary, the third person should be used.