Tehran University Medical Journal

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Background: Medical education is inherently stressful and demanding to deal with various stressors, which may cause impaired judgment, reduced concentration, lack of self-steam, increased anxiety and depression.

Materials and Methods: A cross sectional study was conducted on 250 medical students from 6 month period to graduation in medical college of Tehran university of Medical sciences in order to assess their anxiety and practice of health behaviors and also the relation between the two variables and some other related factors..

Results: The results of study show that of 6.6% medical students suffer from severe state and 4.9% from trait anxiety. The finding of this study shows that 83.3% of girls and 84.6% of boys have practicing risky health behaviors. No statistical relationships found between, anxiety and practicing health behaviors. The relation between anxiety and health satisfaction was Statistically significant mental and physical (P<0.001).

Conclusion: The information found in this research, can help medical education institute to capitalize an opportunities to help their students in preventing risky behaviors, and different stress management techniques should be taught at medical schools.

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Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high psychological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses’ health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care. Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress .The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers.

Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour’s workshop, all subjects were pre and post tested (one month later) for job stress and communication skills with the Karasek’s Job Content Questionnaire (JCQ) and communication skills test.

Results: Results revealed the following: (1) subjects in both groups after pretest were the middle level of stress and communication skills. (2) After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3) After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks.

Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel, thus. It is recommended to apply communication skills training programs for nursing personnel working at rehabilitation centers in order to assist them to coping with their job stress and improve the quality of nursing care.

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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.

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Paget’s disease is a chronic non-metabolic bone disorder that is characterized by increased bone resorption, bone formation and remodeling. This unbalanced process may lead to osseous deformities, structural weakness and altered joint biomechanics all of which can make surgical reconstruction difficult. Although few patients with Paget’s disease ever require surgical treatment, successful surgical management of severe orthopaedic complications has improved the quality of life for these patients. Surgical options include osteotomy to restore long bone deformity and arthroplasty to correct altered joint mechanics. Patients are at increased risk for surgical complication such as blood loss and heterotopic bone formation. Issues relating to the surgical management of patients with Paget’s disease such as appropriate preoperative diagnosis, technical challenges of surgery, and strategies to improve the long-term outcome of surgical intervention are discussed.

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Background: Rheumatoid arthritis (RA) is an autoimmune disorder with unknown etiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis. The aim of this study was to analyze the level of activities of catalase, glutathione peroxidas (GSH-Px), Super oxide dismotase (SOD) in patients with RA compared with the healthy subjects.
Methods: In a case-control study sixty rheumatoid arthritis patients 18-75 years old and 60 healthy sex and age-matched controls were selected, Catalase activity was measured by determining the constant rate (k) of hydrogen peroxide decomposition. GSH-Px activity of plasma was measured with spectrophotometer by Glutathione oxide generation due to GSH-Px. SOD activity is measured by degree of inhibition effect of SOD in generating super oxide radicals by xanthine and xanthine oxidase. C-reactive protein and rheumatoid factor values were determined by agglutination and latex tests.
Results: The plasma activity of catalase (p<0.001), GSH-Px (p<0.01), plasma level of hemoglobin and hematocrit (p<0.05) were significantly lower in patients with RA comparing with controls. The reduction in SOD activity was not significant (p>0.05). There was a negative significant relation between C reactive protein and Rheumatoid factor values with the erythrocyte activity of catalase and GSH-Px (p<0.01).
Conclusion: These results suggested that oxidative stress plays a very important role in the inflammation and pathogenesis of RA.

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At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy “as is your pathology so is your medical practice”. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes ,clinicians’ and pathologist’ reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities. Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% (on average 23.5%) of clinically missed diagnoses and managements involving the principal or underlying cause of death. The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understand-ing of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals. We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities.

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Background: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. The clarithromycin–based regimen is not cost – effective for developing countries and also there is a lot of evidence about increase of clarithromycin resistance H-pylori. Furazolidone is a good substitute, but several side effects, limit its widespread use our previous revealed that most of side effects occurred in the beginning of second week of treatment, so decrease the period of furazolidone therapy to one week may be considered. The aim of the present study was to assess the efficacy and side effect of one week furazolidone in combination with bismuth subcitrate ,amoxycillin and omprazole
Methods: In this study, a total of 177 patients were enrolled and randomized to two groups and received the following medications: Group I: omprazole 220mg + amoxycillin 21gr + bismuth subcitrate 4120 mg for two weeks and furazolidone 2200mg for 1 week Group II: the same regimen as in group I except that one week furazolidone in group II patients followed by one week metronidazole 2500 mg/day (one week furazolidone and one week metronidazole).patients were followed after 2 weeks for side effect of drugs and compliance and control endoscopy was performed after 6 weeks and three biopsies spicimens from the antrum and three from the corpus were taken for a urease test and histology. Eradication was concluded if all the tests were negative for H-pylori Results: One hundred fifty seven patients completed the study. Mean age was 38.84+10.42 and 55.4% were male and 44.6% were female. Two patients from group I and three patients from group II did not tolerate the regimen and were excluded from the study. No serious complication was detected in two groups. The eradication rate per protocol analysis and intention to treat analysis were 89% and 79.3% in group 1 and 86.6% and 74.4% in group 2.No significant statistical differents between two groups (P=0.32 , P=0.33).
Conclusion: One week furazolidone in combination with two weeks amoxicillin, omprazole and bismuth subcitrate is a good, safe and cost effective regimen for eradication of H-pylori. Addition of metronidazole in the second week of treatment period did not increase eradication rate.

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Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.
Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.
Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.
Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

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Background: Diabetic neuropathy is an incapacitating disease that afflicts almost 50 percent of patients with diabetes. A late finding in type 1 diabetes, diabetic neuropathy can be an early finding in non insulin-dependent diabetes. Diabetic neuropathies are divided primarily into two groups, sensorimotor and autonomic. Patients may acquire only one type of diabetic neuropathy or may present with combinations of neuropathies, such as autonomic neuropathy or distal symmetric polyneuropathy, the latter of which the most common form. Motor deficits, orthostatic hypotension, silent cardiac ischemia, hyperhidrosis, vasomotor instability, gastroparesis, bladder dysfunction, and sexual dysfunction can also result from diabetic neuropathy. Strict control of blood sugar, combined with proper daily foot care, is essential to avoid the complications of this disorder. With the potential to afflict any part of the nervous system, diabetic neuropathy should be suspected in all patients with type 2 diabetes as well as patients who have had type 1 diabetes for over five years. Although some patients with diabetic neuropathy notice few symptoms, upon physical examination mild to moderately severe sensory loss may be noted by the physician. Idiopathic neuropathy has been known to precede the onset of type 2 diabetes.

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Background: Percutaneous Coronary Intervention (PCI) for bifurcated lesions is associated with a low rate of success and high rate of complications compared to such treatment of lesions of most other morphologies. Symptoms occurring at the time of procedure caused by PCI may require additional angiography with or without stenting through stent struts, which subsequently increases risks of restenosis and stent thrombosis. The purpose of this study was to evaluate the incidence of major side branch (>1mm) complications during PCI and their clinical, angiographic, and interventional predictors.
Methods: Of 104 consecutive patients, we evaluated 50 lesions with ostial stenosis (group 1) and 54 lesions without ostial stenosis (group 2) as a control group. Age, sex, major coronary artery disease risk factors, and left ventricular ejection fraction (LVEF), were compared between groups. Morphology, location, type of lesion, length of lesion, main and side branch diameters, interventional approach, and clinical and interventional outcomes were the main variables studied during this trial.
Results: Side Branch Compromise (SBC) occurred in 41 (39.4%) of the total number of cases: 52% in group 1 and 27.8% in group 2 (p=0.01). More than 80% of SBC occurred in main branches with stenosis (p=0.02). SBC did not correlate with clinical characteristics, bifurcation location, LVEF, or stent number. Chest pain was reported in 18% of the cases during or after PCI. Three non Q wave myocardial infarctions (MI) occurred after SBC, each with >2 mm branch diameters (p=0.02). SBC was not associated with adverse clinical outcomes.
Conclusion: The risk of MI after losing the side branch of a bifurcation lesion is not usually as high as it is after losing the main branch. Furthermore, it may not be a serious problem as one of the problems of the bifurcation lesion is the high rate of post procedural non Q wave MI associated with SBC. These findings demonstrate that side branch ostial stenosis >50%, and main branch stenosis >80% were important predictors of SBC. Protection of side branches >2mm is highly recommended during coronary intervention.

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Background: The common cold is the most prevalent sickness and an important cause of absence from job. Furthermore, it often disturbs travel, including the practice of hajj, causing the use of many inappropriate drugs by these travelers. The health belief model is a psychological model that attempts to explain and predict health behaviors. The purpose of this study was to determine the effects of zinc and health belief model based educational intervention on the behavior of hajj travelers with regard to viral upper respiratory tract infections (URTI).

Methods: This double-blinded randomized controlled trial was performed among hajj travelers in 2005. Preventive measures were randomly allocated to four groups: 1- education + zinc sulfate. 2- education + placebo. 3- zinc sulfate only 4- placebo only. Data regarding incidence and duration of URTIs, background disorders, vaccination and health behaviors for cold were gathered by questionnaire by physicians and finally analyzed by SPSS 11.5 software using chi-square, t-test and independent samples t-test.

Results: A total of 646 travelers were studied. The incidence of common cold in groups receiving zinc were significantly less than that for those receiving the placebo. (P=0.05). However, incidence was statistically the same for those who received education versus those who did not. Use of handkerchief was the most prevalent behavior and use of mask was the least prevalent behavior. Mean duration of symptoms was less in those receiving zinc and education (3.7 days) comparing to those who received placebo and education (5.6 days). 

Conclusions: This study showed that zinc consumption can decrease the incidence and duration of the common cold. Health belief model based education could promote some preventive behaviors although most people do not take advantage of them. We recommend the use of zinc by those attending hajj.

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Background: The aim of this study was to estimate the prevalence, severity, and risk factors for diabetic retinopathy in diabetic cases admitted for non-ocular diabetic complications and to investigate the association between retinopathy and these complications.

Methods: In this cross-sectional study, 84 diabetic patients admitted to our university-affiliated hospital for non-ocular diabetic complications were fully evaluated for proliferative and nonproliferative diabetic retinopathy. Cases of nonproliferative retinopathy (NPDR) were graded as microaneurysm, mild, moderate or severe. To determine the association of retinopathy with the complications that caused hospitalization, statistical analysis was performed using SPSS ver. 11.5.

Results: The prevalence of diabetic retinopathy among our cases was 77.4% (65 patients), with proliferative diabetic retinopathy (PDR) present in 23 patients (35.4% of the retinopathy cases). Diabetic retinopathy was higher in patients who had been hospitalized for nephropathy than in patients with diabetic foot and diabetic ketoacidosis (DKA, p=0.001), and higher in those hospitalized for diabetic foot than for DKA (p=0.008). Among the 35 patients who had nephropathy and retinopathy, 16 subjects (45.7%) had PDR, and the other 19 subjects had NPDR. Twenty-seven patients had diabetic foot and retinopathy, six (22.7%) of whom had PDR, and 21 (77.8%) had NPDR. Factors significantly related to the occurrence of diabetic retinopathy were type 2 diabetes, presence of hypertension, elevated serum levels of creatinine, duration of diabetes and coexisting nephropathy or diabetic foot (all with p values <0.05). In the logistic regression model, diabetic duration had a slight association with PDR (p=0.06).

Conclusion: Our data suggest that diabetic retinopathy in our patients is common, especially in patients with nephropathy. In addition to glycemic control, lowering of serum cholesterol and triglycerides as well as blood pressure may be effective in lowering the prevalence of diabetic retinopathy.

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Background: Nasogastric tube (NG tube) usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases.

Methods: This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound (BS) upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5.

Results: After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for placing/replacing the NG tube was the same for both groups. There was no difference in the perioperative death rates between the two groups.

Conclusions: We conclude that the routine use of NG tubes after surgery is not recommended for all patients. NG tube should be used according to the specific needs of each patient. This protocol will protect patients from undesired complications.

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Background: The value of the mandibulo-canine index (MCI) in gender identification has been proved in some studies in various countries. The goal of our study was to determine the utility of MCI in gender identification in Iran.

Methods: This descriptional survey was performed on a group of 18- to 25-year-old Iranian students at the Tehran University of Medical Science. We included 50 males and 50 females that were selected using a single sampling method. Data were statistically analyzed by SPSS (v. 13) and t-test.

Results: No statistically significant difference was found between the mean ages of the two groups. Among men, the MCI ranged from 0.209 to 0.293, with a mean of 0.252. Among women, the MCI ranged from 0.202 to 0.276, with a mean of 0.245. There was significant statistical difference between the two means, (0.007 P value = 0.04). The standard MCI of 0.247 was compared to that of each gender, after which no significant statistical difference was found between the two genders (P value = 0.8).

Conclusions: Despite some studies performed in other countries displaying the usefulness of MCI in sex determination, our data did not support this conclusion. Perhaps this difference can be explained because of the variety ethnic groups from various cities of Iran represented in this research had some influence on the results.

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Background: Cervical cancer is the second most common cancer of the women worldwide. It is also an important cause of cancer-related mortality in women, after breast cancer. Nearly half million of new cases are identified yearly. The incidence rate in developing countries is greater than the developed countries. Epidemiologic studies have shown that the association of genital human papilloma virus (HPV) with cervical cancer is strong, independent of other risk factors, and consistent in several countries. The aim of this study was to determine the frequency of HPV in patients with high grade cervical intraepithelial neoplasia (CINIII, CIN II) and squamous cell carcinoma (SCC) of cervix.
Methods: Hundred specimens from patients with SCC and CINIII, CIN II, confirmed by histological review, referring to Mirza Koochak Khan Hospital from 1999-2004 were enrolled in a cross sectional study. Polymerase chain reaction was utilized for identification and typing of HPV DNA. To increase the sensitivity of HPV detection, nested PCRs were performed using MY09/MY11 as outer and GP5/GP6 as inner primers.
Results: It was possible to extract 77 of 100 specimens that HPV DNA was detected in 47 of 77 specimens. Infection with HPV was present in 32 specimens (86.5%) among SCC patients and in 15 specimens (37.5%) among CINIII, CIN II patients. The most frequent HPV types in SCC patients were HPV 16 and 18 (59.38%) and then 33 (34.38%) and in CINIII, CIN II patients was 16 (53.33%) and 18 (40%). the most frequent co-infection in both groups was HPV 16 and 18 which was present in 40.62% and 26.7% of cases respectively.
Conclusions: The most frequent HPV types in patients with SCC and CINIII, CIN II was 16 and 18 that is identical to many other countries infection pattern.

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Background: Immediately after Comprehensive Medical Basic Sciences Examination (CMBSE), the secretariat of the Medical Basic Sciences Education Council (MBSEC) proceeds to rank medical universities according to the students’ scores both in individual academic subjects such as biochemistry, English and in all subjects put together. This study believes that the method used in ranking the universities according to the students’ English scores is not a proper method and thus doesn’t provide accurate results.
Methods: Seven of the major and smaller universities were selected. The language scores of all the students admitted to the medical schools of these universities during 3 academic years of 1378 to 1381 (2426 students in all) in both CMBSE and National university Entrance Examination (NUEE) were obtained. The language scores of each students in NUEE and CMBSE were matched.
Results: A significant correlation (max. R=69%, P<0.004 to min. R=27%, P<0.045) was observed between these two grades in all universities studied. Moreover despite the secretariat’s decision to calculate the scores and rank the universities in two separate groups of major and small universities, in some CMBSEs certain smaller universities were ranked in the group of major ones and in some others vice versa.
Conclusions: This has impaired the university ranking in the subject of English language. This study proposes two different ranking methods, that eliminate the present drawback in university ranking according to their student’s English scores.

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Background: There are many methods for removal of tracheobronchial foreign bodies but there are many situations where removal of a foreign body seems impossible and may require a major surgical procedure. Familiarity with each method improves physician decision making.
Case: A 17 months old baby with a history of foreign body aspiration suffered from long term pneumonia. There was a round shape foreign body in bronchoscopic view that could not be removed with standard methods, but was removed by application of Fogarty catheter Conclusion: Removal of round, spherical foreign bodies may be performed by Fogarty Catheter preventing surgical intervention.

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Background: Acute appendicitis is one of the most common abdominal emergencies. Many studies comparing the two routes of open and laparoscopic appendectomy have been performed comparing the duration of each operation, duration of hospitalization, amount of post-operative pain medication required and infectious complications were the most commonly evaluated factors.

Methods: This clinical trial study, performed between March 2005 and March 2006 at Golestan and Imam Khomayni hospitals in Ahvaz, Iran, included 100 patients. Open appendectomy and laparoscopic appendectomy were carried out on 50 patients each. Duration of surgery and hospitalization, amount of pain medication and infectious complications were compared, with chi-square, ANOVA and t-test used for statistical analysis.

Results: The average length of hospital stay for laparoscopic appendectomy was 44.48 hours and for open appendectomy was 54.80 hours (p<0.01). The average of amount of pain medication for laparoscopic appendectomy was 2.40 doses and for open appendectomy was 30.46 doses (p<0.01). The laparoscopic and open procedures averaged 31.8 and 35.2 minutes, respectively (p=0.5). Only one (2%) laparoscopic case had infection, while four (8%) open appendectomy subjects suffered from this complication. Patients who underwent laparoscopic appendectomy had no intra-abdominal abscesses.

Conclusions: Duration of hospitalization was statistically much shorter using the laparoscopic appendectomy than that of the open procedure (P<1%). The amount of pain medication administered was also statistically less in the laparoscopic procedure (P<1%). However, the amount of time to complete each procedure was not statistically different. Most importantly, complications such as wound infection and intra-abdominal abscess were remarkably less using laparoscopy. We recommend laparoscopic appendectomy over open appendectomy.

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Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women) with a mean age of 50 years (range: 19-83 years) in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.
Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%). The most frequent late-onset medical and mechanical complications were peritonitis (6.3%) and hernia (3.7%). During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.
Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.