Showing 5 results for Keshvari
Amir Keshvari, Mahboob Lesan Pezeshki, Masoud Younesian,
Volume 64, Issue 6 (3 2006)
Abstract
Background: The aim of this study was to evaluate the mechanical and infectious complications of continuous ambulatory peritoneal dialysis catheter in surgical wards of Imam Khomeini Hospital.
Methods: We retrospectively reviewed 80 catheters that were inserted into 69 patients (52 men and 28 women) with end-stage chronic renal failure during a period of 84 months (13 Nov. 1996 to 13 Nov. 2003.
Results: The mean age of patients was 48:35 years (16 to 79 years). The most common complications were infectious ones (71.25%), while the most common causes of the catheter removal were mechanical ones (46.5% vs. 39.55%. The predominate cause of the mechanical complications was improper position (17.5%). Migration of catheter to upper abdomen and outflow failure were the other common mechanical complications. The most common infectious complication was peritonitis (62.5%).
Conclusions: The occurrence of the mechanical complications is lower than the infectious ones, but the probability of catheter loss is higher if it occurs.
Keshvari A, Jafarian A, Makarem J, Rabbani A, Mirsharifi Sm,
Volume 65, Issue 2 (8 2008)
Abstract
Background: For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical examination of arteriovenous fistula by the surgeon at the end of the surgery was evaluated.
Methods: In the general surgery ward of Imam Khomeini Hospital in 326 chronic renal failure patients, 354 arteriovenous fistula operations were accomplished by two surgeons from 1377 to 1381 (ca. 1998 to 2002). The performance of each fistula was divided into the following groups by the surgeon at the end of operation: 1) systolic and diastolic thrill, 2) systolic thrill 3) souffle 4) pulse 5) not functional. Clinical function of the fistula was evaluated by the same surgeon in the following days if no souffle or thrill, early failure was detected on initial inspection.
Results: In the 354 cases of arteriovenous fistula, the total early failure rate was 12.7%. The lowest early-failure rate was 3.5% in the systolic and diastolic thrill group. The highest early-failure rate was in the not functional group (P<0.001). There was no correlation between early failure and age, sex, surgeon and location of fistula.
Conclusion: Optimally, an arteriovenous fistula has a thrill with a soft compressible pulse. At the end of each operation, if the surgeon cannot detect a thrill at the fistula site, can find only pulse, or if the function is otherwise unsatisfactory, considering of a new arteriovenous fistula may be required, however it is better to postpone the surgery.
Keshvari A, Jafari- Javid M, Najafi I, Chaman R, Nouri Taromloo Mk,
Volume 66, Issue 7 (6 2008)
Abstract
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Background: Chronic peritoneal dialysis
is a safe method for the treatment of end-stage renal failure. Worldwide,
patients on chronic peritoneal dialysis constititute approximately 15%
of the total number of patients on dialysis. In Iran, very few people have access
to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This
lack of access is primarily due to the high occurrence of mechanical
complications. Improving catheterization procedures is an important way to
extend the use of peritoneal dialysis in Iran. Thus, a prospective study was
implemented to evaluate the outcome of a new laparoscopic technique for the insertion
of peritoneal dialysis catheters under local anesthesia.
Methods: A
total of 115 catheters (two-cuff, swan-necked, coiled) were
inserted into the peritoneal cavity of 109
patients with end-stage chronic renal failure during a 16-month
period. The method of insertion was a two-port laparoscopic technique with
local anesthesia and sedation. All patients were followed for 12
to 28 months. We prospectively evaluated mechanical
and infectious complications and survival rates of the catheters.
Results: The
average age of the patients was 51.5 years (range: 15-84
years) 54.8% of these patients were female. The overall
one-year and two-year catheter survival rates using this approach were 88%
and 73%, respectively. Event-free catheter survival
was 35%. The most common infectious and mechanical
complications were peritonitis in 52
cases (45.2%) and temporary dialysate leakage in 10
cases (8.7%) respectively.
Conclusion: Laparoscopic insertion of
peritoneal dialysis catheter with local anesthesia is a safe and simple
procedure, giving reasonable rates of catheter survival and complications.
Amir Keshvari , Mohammad Sadegh Fazeli , Alireza Kazemeini , Alipasha Meysamie , Mohammad Kazem Nouri Taromlou,
Volume 71, Issue 10 (January 2014)
Abstract
Background: Colorectal carcinoma is considering as a curable disease. Treatment of recurrent cases is hard and sometimes impossible. Evaluation of the rate and affecting factors of recurrence in each hospital would help to decreasing recurrent cases. The aim of this study is evaluation of the rate, clinical and pathologic features, and outcome of recurrent colorectal carcinoma in a referral teaching hospital in Tehran.
Methods: Clinical data of 166 curative resections of colorectal carcinoma who were operated between Mehr 1384 and Mehr 1388 (between 23 September 2005 and 23 September 2009) in Imam Khomeini Hospital and were accessible for follow up was collected. Follow up data was collected prospectively up to Farvardin 1391 (19 April 2012). Forty nine recurrences were happened in this period. We compared recurrent and non-recurrent cases for different variables
Results: Average age of the patients was 53.5 years, and 47% of them were female. The median time to the diagnosis of recurrent disease was 12 months (range 1 months to 54 months). There were no significant differences between recurrent and non-recurrent patients about age, sex, sub-site of the tumor and sub-type of primary operation. Rate of overall recurrence, local recurrence and distant metastasis were 29.5%, 15.7% and 12.1% respectively.
Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%). Rate of curative re-resection was about 25%. Overall survival of the recurrent patients who underwent surgery was better than who underwent chemo or radiotherapy (66.7% vs. 56.8%). Median survival time of recurrent patients after primary surgery was 28 months, and after diagnosis was 12 months (9.28- 14.72,95% CI).
Conclusion: In this study the rate of overall recurrence was 29.5%. Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%).
Amir Keshvari , Mohammad-Sadegh Fazeli , Alireza Kazemeni , Alipasha Meisami , Mohammad-Kazem Nouri-Taromloo,
Volume 72, Issue 12 (March 2015)
Abstract
Background: Sacrococcygel region is the most common site for pilonidal sinus and surgery is the most common treatment for it. Numerous operative techniques have been described for management of this disease but a technique with low recurrence and complication rates is the best treatment option. Karydakis has been introduced as a method with less recurrence rate, but it seems that surgeons debate on complications and it is not a common technique in our country. In this article, we will discuss Karydakis procedure and its results after a prospective follow-up in our patients.
Methods: This is a prospective single cohort study on the patients with sacrococcygeal pilonidal disease. Cases evaluated in this study included patients underwent Karydakis procedure for their pilonidal sinus from 23 September 2006 to 22 September 2013. Patients were followed-up prospectively after their discharge within the first week, first month and third month for early complications and then annually for recurrence. The length of follow-up ranged from 3 to 77 months (median 36 months).
Results: Of 141 patients, 119 (84.4%) were male and mean operating time was 55.52 (35-120) minutes. Mean time to healing wound with no need to dressing was 15.92 (range: 2-120) days and mean time to return to work was 14.44 (range, 1-35) days. Overall rate of early post-operative complications was 21.3% that most of them treated conservatively. Wound breakdown within the caudal part was the most common complication detected in 12.1% of patients and infection was detected in 5.8%. Hematoma, seroma and complete wound breakdown were seen in one patient each. The mean score of patient's satisfaction after one year was 4.91 out of 5. Recurrence was appeared in 1.42% of patients.
Conclusion: Karydakis procedure for sacrococcygeal pilonidal disease is associated with low complications, short healing time and return to work, and reasonable recurrence rate.
