Showing 55 results for Surgery
Bitara Ma, Azar M, Miri Sm, Sheikhrezai A, Alikhani M, Allahverdi M, Sharif Tabrizi A, Tayebi Meybodi A,
Volume 68, Issue 3 (6-2010)
Abstract
Background: Meningiomas are among the most common tumors of the brain. Skull base meningiomas comprise s major part of brain meningiomas. They are difficult to treat because of proximity to major vital neuro-vascular structures which makes their surgical resection hazardous and fraught with a high rate of complications. Radiosurgery is considered as an alternative efficient way to treat them, which targets the tumor and its supplying vasculature. The standard treatment consists of tumor eradication and its supplying vessels through homogeneous dose of 201 rays of cobalt
60 source.
Methods: In a case-series study, we report 230 meningiomas referred to Iraninan Gamma Knife Center, treated by radiosurgery with type C Gamma Knife. Radio-surgery was performed at a mean dose of 15 Gy and 50% isodose.
Results: Two hundred and thirty of all meningioma cases refered to our institute were skull base lesions. Eighty (35%) were new case and the rest were previously treated microsurgically one or more times. None of the patients died after treatment and the most common post-operative complications were headache (30 patients) and peri- tumoral edema (12 patients).
Conclusion: Tumoral control is defined as reduced tumor volume or as no change in tumor volume. Tumor control was achieved in 218 (95%) patients. In those who were not treated microsurgically, clinical improvement was more pronounced. Thus when suitable (favorable tumor size and absence of progressive mass effect signs) the patients could be primarily treated with Gamma knife. Other patients could be managed complementarily with radiosurgery after they are treated surgically.
Kaviani A, Taslimi Sh, Athari B, Yunesian M, Hosseini M, Rabbani A,
Volume 68, Issue 4 (7-2010)
Abstract
Background: The oncoplastic surgery has been revolutionized breast conservative surgery. The aim of our study was to represent the cosmetic outcome of oncoplastic breast surgery in Iran and to evaluate its determinants.
Methods: Fifty eight patients with unilateral breast neoplasm operated with single surgeon in Imam Khomeini Hospital, Tehran, Iran. Three view photographs were obtained pre and post operatively and were put in separate PowerPoint slides. The photographs were evaluated by six health related professionals. They scored the cosmetic outcome with modified questionnaire containing general and specific questions. Weighted kappa used for intra and inters rater reliability and ANOVA was used for analyzing cosmetic outcome determinants.
Results: Generally, 72.2% of the photographs got the excellent or good score in a single breast evaluation part. Its items breast size, nipple deviation and scar quality scored 94.2, 67.9 and 88.8 respectively. "In comparison with contra-lateral breast" part shape asymmetry, need for surgery of contra lateral breast and size asymmetry scored 68.9, 75.8 and 69% respectively. Tumor size greater than two cm had poorer outcome (p=0.039) upper outer quadrant tumor had the worst and upper inner quadrant tumors had the best outcomes (p<0.0001). Patient with 50 to 60 years of age had the poorest outcomes (p<0.0001). Weighted kappa for inter and intra rater kappa was 0.12 and 0.58 respectively.
Conclusions: Acceptable cosmetic outcome is obtained in the first experience of oncoplastic breast surgery in Iran. Long term monitoring of oncologic and cosmetic outcomes in greater numbers of patients is recommended.
Forouzan Nia Skh, Hadadzadeh M, Mirhosseini Sj, Hosseini H, Abdollahi Mh, Forat Yazdi M, Rasti M, Dehghanizadeh H, Ghoreishian Sm,
Volume 68, Issue 9 (12-2010)
Abstract
Background: One of the most important components of coronary
artery bypass graft surgery is need for blood transfusion that increases
morbidity and mortality. The aim of this study was to evaluate the factors
affecting the need for blood transfusion during off pump coronary artery bypass
(OPCAB)
surgery.
Methods: In
this descriptive case control study 923
patients who had undergone OPCAB at Afshar Hospital in Yazd,
Iran, from July 2008 to January 2010
were evaluated. The data was gathered from their records and was analyzed.
Results: 54% of
male and 79% of female patient need
blood transfusion. Mean age in patients needed transfusion was 61.58±11.11
years and in other group was 60.27±10.98
years of the patients that needed transfusion (p= 0.08). 563
(61%) of the patients needed transfusion with the
average of two units. The need for blood transfusion was higher in female
gender (p< 0.0001),
low hematocrit (p< 0.0001),
diabetes (p< 0.001),
hypertension (p< 0.025)
and multiple grafts (p< 0.027).
There were no significant differences in preoperative hemostasis tests,
affection to hyperlipidemia, CVA or
renal failure, antiplatelet drug administration and the application of left internal
mammary artery between the transfusion and non transfusion groups.
Conclusion: In this study preoperative
hematocrit was most important risk factor in transfusion in patients that
underwent OPCAB. Female gender, preoperative
low hematocrit, multiple grafts, diabetes and hypertension increased the rate
of blood transfusion. According to the high prevalence of blood transfusion in OPCAB, considering factors that
affect the transfusion rate is essential.
Sadeghi Sm, Seyedmehdi Sa, Narimani Zamanabadi M, Sadeghi Sa,
Volume 68, Issue 12 (3-2011)
Abstract
Background: Sinus surgeries are usually associated with bleeding, thus can result in
hemodynamic instability. This study investigated the hemodynamic changes induced by remifentanil plus isoflurane administration in comparison with
propofol plus remifentanil in patients undergoing sinus surgery.
Methods: In this randomized clinical trial study, 96 patients were divided into two groups of isoflurane (1.2 MAC) plus remifentanil (44 patients, group A) and propofol (100 μg/kg/min) plus
remifentanil (52 patients, group B). Twenty-two patients in group A and 23 in group B were male. The remifentanil dosage (0.1 μg/kg/min) was equal
in both groups and all received 500 ml isotonic solution during the operation too. Premedications and anesthetic inductions of both groups were similar. The variables included age, BMI, blood loss during surgery, systolic and diastolic blood pressures, pulse rate and mean arterial blood pressure.
Results: The mean age, BMI, amount of blood loss, mean systolic (30 minutes before and after the intervention) and diastolic blood pressures (60 minutes before and after the intervention), pulse rate (30 and 60 minutes before and after the intervention), mean arterial blood pressure (60 minutes before and
after the intervention) were similar in both groups. The average mean arterial blood pressure, 30 minutes after the intervention (p=0.027) and the mean
diastolic blood pressure, 30 minutes after the intervention (p=0.011) in the case group had statistically significant differences with the controls.
Conclusion: Based on this study, the combination of isoflurane plus remifentanil could better maintain the hemodynamic stability during sinus surgeries.
Fathi Hr, Fathi M, Harirchi I, Tavangar K,
Volume 69, Issue 1 (4-2011)
Abstract
Background: Reconstruction by free tissue transfer and microvascular anastomosis can
provide a reliable repair for tissue defects in head and neck surgeries. During this study, we evaluated the clinical characteristics and outcomes of reconstructive surgery by the use of free flaps for defects resulting from head and neck cancers.
Methods: This quasi-experimental study included 29 patients having been diagnosed with head and neck cancers and referred to the Plastic Surgery Clinic and Cancer Institute of Imam Khomeini Hospital Complex in Tehran, Iran, for the resection of cancerous tissue. After operation, the patients were followed-up for three months and the surgical outcomes were evaluated.
Results: The mean age of participants was 50.8 ± 15.1 yrs. Two patients (6.9%) had total and three (10.3%) had partial flap loss. The rate of total and partial flap loss in this study was less than 10%. There were no differences between groups with total and
partial flap loss regarding mean age, mean operation time, and mean perioperative
ischemia time. Prothrombin time (PT) and international normalized ratio (INR) were significantly different in patients with total flap loss compared with patients with successful reconstruction. The INR for the group with total loss was 2.2 and 1.2 ± 0.3 for other patients (P=0.0006). The mean ACT was 46 seconds in patients with total flap loss and 82 ± 18.9 seconds for other patients (P=0.08).
Conclusion: Considering its high success rate, free tissue transfer can be considered as a method for single-stage reconstruction in almost all major head and neck defects.
Mohajer Mr, Karvandian K, Hussain Khan Z, Jafarzadeh A, Dabiran S,
Volume 69, Issue 7 (10-2011)
Abstract
Background: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.
Methods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.
Results: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).
Conclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.
Naraghi M, Madani Kermani Sz, Mohammadnezhad Sf,
Volume 69, Issue 10 (1-2012)
Abstract
Normal
0
false
false
false
EN-US
X-NONE
AR-SA
MicrosoftInternetExplorer4
Background: Osteoma
is a bony slow growing benign tumor in one of the sinuses. It is usually
asymptomatic but clinical symptoms will occur by its overgrowth, occupation of
sinus space and obstruction of ostia.
Methods : This descriptive, cross-sectional, retrospective study was done by accessing
the medical records of 17 patients with paranasal sinuses osteomas admitted in Tehran Amir
Alam Hospital during 1999-2008.
Results : The mean age of the participants was 33.9 years and 12 (70.6%) were male and 5 (29.4%) were female. No positive family histories existed for the lesions. The
mean time interval between the onset of symptom and attending the hospital was 4.4 years.
Frontal followed by ethmoid sinus osteomas were more common in
comparison to other sinuses. The most reported symptoms in frontal sinus osteomas
were upper eyelid inflation and headache and proptosis, nasal congestions and
diplopia in ethmoid sinus osteomas. Most patients had been endoscopically treated.
Conclusion: In small-to-medium-sized osteomas with no invasion
into orbit or skull base, endoscopic surgery is the treatment of choice with
minimum side-effects.
Heydari Sv, Ramak Hashemi Sm, Abasnejad Ea, Abbasi Gravnd F, Ghorbani Yekta B,
Volume 70, Issue 5 (8-2012)
Abstract
Background: The purpose of this study was to determine the prevalence and associated factors for postoperative pulmonary complications (PPCs) and extubation failure in patients having undergone intracranial surgery.
Methods: In this retrospective study done in Firozgar Hospital during 2008-2010, we followed up 254 patients through a clinical questionnaire and observation of the clinical course of participants in pre- and post-operative periods.
Results: Overall, 40 (15.74%) patients had postoperative pulmonary complications. The most common PPC was pneumonia, which was seen in 24 patients (60% of complications). The average duration of ventilation in patients with PPC was significantly higher (16.8.±10 vs. 5.09±4.5 days P=0.001) than patients without the complication. The mean Glasgow coma scale (GCS) after surgery in patients with PPC was significantly lower (11.±4 vs. 13.2±3 P=0.001) than the rest of the patients. Moreover, the mean age of patients with PPC was significantly higher (64.02±14 vs. 41.6.±17 years P=0.001). Average duration of stay in ICU in patients with PPC was also higher (24.±27 vs. 8.7±0.5 P=0.001).
Conclusion: GCS before surgery and failed extubation independently of other variables were significantly associated with pulmonary complications independent of other variables.
Mohammad Reza Khajavi , Amirali Orandi , Pejman Pourfakhr , Farhad Etezadi ,
Volume 71, Issue 8 (11-2013)
Abstract
Background: The Trigemino-cardiac reflex (TCR) has been studied as a phenomenon including bradycardia, arterial hypotension, apnea and gastric hypermotility during manipulation of the peripheral or central parts of the trigeminal nerve.
Case presentation: We report a case of a 26-year-old man undergoing surgery for a skull base extra axial tumor in right petrous bone suspected to metastasis of a previous renal cell carcinoma which had been treated four years ago. The patient presented with continuous and unilateral headache and difficulty in swallowing, sensory neural hearing loss, nasal speech and tongue deviation to left side. He underwent general anesthesia with standard monitoring and total intravenous anesthetic technique. The first episode of sudden onset bradycardia and hypotension related to surgical manipulation was detected intraoperatively in which the heart rate spontaneously returned to normal level once the surgical manipulation stopped. However, it repeated several times by beginning of tumor resection and manipulation in the region of trigeminal nerve. The intensity of bradycardia in subsequent episodes of TCR was relatively crescendo and had no fatigability. Finally, it was treated by administration of a single dose of atropine (0.5mg/IV) and did not happen again.
Conclusion: The risk of TCR should be considered in any neurosurgical intervention involving trigeminal nerve and its branches, especially at the skull base surgeries. The vigilance of the medical team and continuous intraoperative hemodynamic monitoring alerts the surgeons to interrupt surgical maneuvers upon the TCR occurrence, immediately.
Kamyar Tavakkoli Tabassi , Mojtaba Ameli , Leila Gholami Mahtaj,
Volume 71, Issue 9 (12-2013)
Abstract
Background: Various surgical procedures were described for the correction of the external genitalia in male-to-female transsexualism. In all these methods complications such as vaginal stenosis, unpleasant appearance of external genitalia and lack of consent are seen. This paper describes a method of surgery for repair of these complications and success rate of this surgery.
Methods: Reconstructive surgery was performed by one surgeon in 16 patients from 2009 to 2011 in Imam Reza Hospital of Mashhad. Mean age 25.75 years of age from 21 to 31 years. Due to the condition of each patient appropriate reconstructive surgery was performed. These surgeries include: clitoroplasty, inverted U flap, labioplasty, urethroplasty, removal of excess skin and increasing depth of vagina. After the surgery, the patients admitted for complete bed rest up to 5 days. They received postoperative prophylaxis medication for anti-thromboembolic events.
Results: Only 3 complications were seen in all 16 patients. One hematoma of surgery site, one infection of surgery site and a blood transfusion. Eleven patients had history of vaginoplasty using small intestine and 10 patients with penile and perineal skin. From 3 to 24 months follow up after discharge were done, no patient had a major complication in long-term follow up and were generally satisfied with their sexual intercourse.
Conclusion: This study has some limitations. Follow-up of the patients was performed for about one year that longer follow-up for these patients is favorable. Also, evaluation of patients' satisfaction from their intercourse was not performed as systematically with using an standard questionnaire and by a person who is blind to the study. Using this method of restoring external genitalia in the hands of expert surgeon, aesthetic and functional result would be expected very well.
Roghayyeh Borji , Mohammad Reza Khatami, Mohammad Reza Abbasi , Alipasha Meysamie , Khosro Barkhordari , Farah Ayatollah Esfahani, Mina Pashang, Laleh Ghadirian ,
Volume 71, Issue 12 (3-2014)
Abstract
Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery.
Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant.
Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates.
Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.
Seyed Masoud Majidi Tehrani, Hamid Ghaderi , Mahnoosh Foroughi , Manouchehr Hekmat, Mahmoud Beheshti Monfared, Hassan Tatari , Seyed Mohsen Mirhosseini , Zargham Hossein Ahmadi, Zahra Ansari Aval, Seyedeh Adeleh Mirjafari,
Volume 72, Issue 2 (5-2014)
Abstract
Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago.
Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study.
Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%).
Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.
Reza Shariat Moharari, Pejman Pourfakhr , Mohammad Reza Khajavi , Farhad Etezadi , Atabak Najafi ,
Volume 72, Issue 7 (10-2014)
Abstract
Background: Today Anesthesiologists occasionally face with bradycardia during gastric surgery and recognized this phenomenon as a vagal reflex. The objective of this study is finding of anesthesia risk factors for bradycardia and prevention of its hazardous complications during gastric surgeries.
Methods: In this retrospective study, fifty patients undergoing laparatomy and gastric surgery in Sina hospital between September 2009 to September 2013. They had been anesthetized with propofol or thiopental and their maintenance was kept by isoflurane or propofol were enrolled. The age, gender, underlying diseases, drug history, chemotherapy, kind of surgery, heart rate variability, onset time of bradycardia and its complication during a period of four years was noted.
Results: Of Fifty patients, 31 males and 19 females was enrolled in this study. The mean age of patients was 48±8.3 yr all patients had laparatomy under general anesthesia. The kind of surgery were mainly gasterectomy and gastrojejunostomy. The mean onset of episode bradycardia was 24.5±3.5 min after initiation of surgery incision, and most of the bradycardia was mild to moderate (47 patients) that with injection of atropine it resolved. There was no relationships between anesthetic drugs and anesthetic maintenance, age, gender, and incidence of bradycardia event during the surgery. The risk factors of bradycardia were, diabetes mellitus in seven patients, use of beta blockers in 17 patients in perioperative period and gastric cancer and chemotherapy (neoadjuant therapy) in three patients that lead to asystole, they were not response to standard treatment during surgery and lead to death.
Conclusion: The history of gastric cancer and previous chemotherapy might be the only common factors that cause to bradycardia and irresponsible asystole during gastric surgery in these patients. It seems that only close monitoring and vigilant anesthesiologist require for treatment and prevention from adverse effect of such a sever bradycardia event.
Jalal Moludi , Seyedali Keshavarz , Reza Pakzad , Naser Sedghi , Taraneh Sadeghi , Foad Alimoradi,
Volume 73, Issue 11 (2-2016)
Abstract
Background: Recently, the role of inflammation and oxidative stress in the pathophysiology of atrial fibrillation (AF) after cardiac surgery has been emphasized. Vitamin C as an antioxidant important role in reducing the incidence of postoperative atrial fibrillation. This study aimed to investigate, administration of vitamin C, as a way to reduce the incidence of atrial fibrillation after coronary bypass surgery.
Methods: In this double-blind clinical study, 290 patients in Rajaee Heart Center, from March 2013 to December 2014 who underwent coronary artery bypass surgery were randomly divided into intervention and control groups to receive vitamin C and placebo. The intervention group before the surgery in the operating room received 2 grams of vitamin C intravenously then one gram per day for four days prior to surgery. After the operation, the two groups were compared in terms of the following: Atrial and ventricular arrhythmias after surgery, ICU stay and hospital stay and duration of intubation.
Results: 113 cases and 177 controls (191 men and 99 women) with a mean age of 55.40±14.40 years in both groups (vitamin C and placebo) were enrolled. The incidence of postoperative atrial fibrillation was 55% in the placebo group to 35% in the vitamin C group decreased (P= 0.001). Duration of intubation in the intervention group 11.8 and the control group was 14.14 hours (P= 0.004). The amount of drainage was lower in vitamin C group (P= 0.003). Vitamin C had no effect on the rates of hospital and ICU stay (P= 0.075). There was no significant reduction in threatening arrhythmia (VT) and VF in this period (P= 0.159).
Conclusion: Vitamin C supplements may reduce atrial fibrillation after coronary artery bypass surgery also can improve conditions such as reducing the duration of intubation. With regard to the safety, these supplements can be recommended for the prevention of atrial fibrillation before coronary artery bypass surgery.
Pejman Pourfakhr , Vahid Raaefi , Atabak Najafi , Reza Shariat Moharari , Farhad Etezadi , Amirali Orandi , Mohammad Reza Khajavi ,
Volume 73, Issue 11 (2-2016)
Abstract
Background: Pain control after orthognathic surgeries due to severity of pain and limitations of opioids use in these patients are particular importance. The aim of this study was to evaluate the effect of oral gabapentin and intramuscular ketorolac in combination with intravenous acetaminophen for pain control after this surgery.
Methods: This study was a randomized clinical trial (RCT) on 75 patients (18-60 years old American Society of Anesthesiologists (ASA) physical status classification system, I, II) that undergo orthognathic surgery in Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran from June 2013 to August 2014. The patients were randomly divided in 3 groups. All of groups received 1 gr (intravenous acetaminophen) 30 minutes before the end of surgery. The control group (n= 25) received placebo. The second group (n= 25) received 30 mg ketorolac intramuscular after induction of anesthesia and the third group (n= 25) received 600 mg Gabapentin orally 30 minute before the induction of anesthesia. The pain severity score assessed by visual analogue scale (VAS), the level of sedation assessed by Ramsey scale, opioid requirement, nausea and vomiting was recorded in the post-anesthesia care unit (PACU) at 1, 3, 6, 12 and 24 hours after surgery. For rescue pain management intravenous morphine was administered.
Results: Seventy-five patients were enrolled in this study. Use of Ketorolac and gabapentin declines the pain intensity, level of agitation and morphine requirement in the recovery room and early hours in the ward (P= 0.011). The 24-hour opioid consumption, nausea and vomiting was significantly higher in control group compared with the both intervention groups (15±1.4 vs. 5±0.5 mg) (P< 0.05) retrospectively. Mean arterial pressure and heart rate changes was significantly lower in ketorolac and gabapentin groups compare to control group in recovery room (P< 0.05).
Conclusion: The result of this study suggest that ketorolac as well as gabapentin can decline the pain intensity and opioid requirement with less nausea and vomiting and good hemodynamic control after orthognathic surgery.
Ali Mohammad Mosadeghrad , Fatemeh Khalaj ,
Volume 74, Issue 5 (8-2016)
Abstract
Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.
Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.
Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.
Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.
Zohreh Yousefi , Sima Kadkhodayan , Maliheh Hasanzadeh Mofrad , Behroz Davachi , Mansoureh Mottaghi , Elham Hoseini , Monavar Afzalaghaee , Asieh Maleki ,
Volume 74, Issue 9 (12-2016)
Abstract
|
Background: Surgical staging is the standard treatment of ovarian cancer. Pelvic and para-aortic lymphadenectomy is the important part of the surgery. The aim of this study was to evaluate the effect of para aortic lymph node dissection in early stage of patients with ovarian cancer.
Methods: This descriptive cross-sectional cohort study was performed on all stage I of ovarian cancer patients admitted in department of gynecology oncology of Ghaem Hospital, Mashhad University of Medical Sciences in November 2012 to March 2014. Every patient with clinical early stage of ovarian cancer candidate to surgical treatment selected. All cases underwent surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy. In laparotomy after identification of left and right iliac artery, all lymph nodes have been properly exposed and dissected as a part of a staging laparotomy. The dissection was continued up to the nodal tissues surrounding the aorta, and inferior vena cava, until inferior mesenteric artery lymphadenectomy level. The procedure performed only by gynecologist oncologist. In addition, we assessed other parameters such as operation time, estimated blood loss, associated mortality and morbidity and vascular injuries. Finally, the effect of para aortic lymph node dissection in early stage of ovarian cancer evaluated.
Results: Among a total of 57 ovarian cancer patients, 27 of them apparent stage I disease cases were selected. Surgical staging surgery with concurrent systematic pelvic and para-aortic lymphadenectomy was carried for all of them. Positive para-aortic lymph node was found only in one case. The average number removed para-aortic lymph nodes in the pelvis was 9 and in para aortic was 7, respectively. In addition, 20 minutes increase in total length of operation time was observed duo to para-aortic lymphadenectomy. Also the rate increase in intra-abdominal hemorrhage rate was estimated 60 ml.
Conclusion: Lymph node dissection will produce a significant benefit in accurate and complete surgical staging. Staging surgery in addition to systematic pelvic and para aortic lymph adenoctomy in early stage ovarian cancer is preferred in gynecologic oncology centers.
|
Alireza Atashi , Shahram Amini , Erfan Ghasemi , Shima Sheybani , Saeid Eslami ,
Volume 76, Issue 4 (7-2018)
Abstract
Background: Various prediction models have been developed aiming to estimate risk-adjusted mortality, morbidity and length of intensive care unit stay following cardiac surgeries. The European system for cardiac operative risk evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death. The objective of this study was to evaluate the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries.
Methods: A prospective cross-sectional study was conducted to collect required variables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized a cardiologist or a general physician evaluated pre- peri- and post-operative state to fill out the pre-designed structural paper form. Comparing the observed and expected mortality, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and finally the discrimination power of the model for our patients were calculated and reported. The model value was calculated using the online tool.
Results: A total of 1337 patients (60% males) were included, the observed mortality rate was 3.2%. Although the overall performance was acceptable, the model showed poor discriminatory power (AUC=0.667, CI 95%: 0.648-0.685) and accuracy with sensitivity=61.88% and specificity=66.23%.
Conclusion: Our single-center study, based on consecutive patients who underwent cardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overall performance with poor discrimination and calibration measures remain as concerning issues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.
Mohsen Sokouti , Behnam Yazdani , Shima Jafari Jebeli ,
Volume 76, Issue 9 (12-2018)
Abstract
Background: Approach to treat empyema following pulmonary infection, especially in the second stage, is disputed. Therefore, this research aimed to compare the effect of simple tube thoracostomy versus surgical debridement in complicated parapneumonic empyema management.
Methods: This prospective randomized trial was conducted in Thoracic Surgery Department of Imam Khomeini Hospital of Tabriz and Dr. Shariati Hospital of Isfahan cities, Iran from March 2003 to September 2015. 104 patients with stage II empyema, divided into two groups (52 patients in each group). Group 1 was treated with simple tube thoracostomy and group 2 with surgical debridement with thoracotomy or thoracoscopy and patients had at least 2 referral after discharge. Personal information, medical history and information of complications and recurrence were recorded in two forms. Finally, data analysis was done by SPSS software version 22 (IBM SPSS, Armonk, NY, USA) and methods of Chi-square test and independent sample t-test.
Results: The age-mean of patients under study was 48.17±11.13 years in group 1 and 46.21±13.58 years in group 2 and the most patients were middle-aged (between 40 to 50 years). The number of men in both groups was more than women. 44.23% of patients in group 1 and 38.46% of patients in group 2 had a history of smoking. Duration of hospitalization (P=0.005), a chest tube duration (P=0.004) and duration of treatment (P=0.005) in group 2 was significantly higher than group 1. The complications (P=0.172) and recurrence (P=0.324) in group 2 are non-significantly more than group 1. The complications of treatment, after a week in group 1, are non-significantly higher than group 2 (P=0.690), but complications of treatment after a month in both groups were equal (P=1).
Conclusion: Duration of hospitalization, chest tube insertion time and duration of treatment in simple chest tube drainage treatment is shorter than surgery treatment (thoracoscopy or thoracotomy) and simple chest tube drainage treatment is more effectiveness way to treat patients with complicated parapneumonic empyema in stage 2.
Ehsan Aghaei Moghadam , Mohammad Reza Mirzaaghayan, Azadeh Sayarifard , Marjan Kouhnavard , Azin Ghamari ,
Volume 77, Issue 7 (10-2019)
Abstract
Background: Growth disturbance is a common phenomenon in children with congenital heart diseases (CHD). Malnutrition and nutritional disturbances have a higher prevalence among children with down syndrome, especially children with Down syndrome; on the other hand, the prevalence of CHD is higher among syndromic children, which needs surgical repair as the definitive treatment. The nutritional status plays an important role in determining the postoperative complications and recovery. The purpose of this study was to investigate the growth status of children with Down syndrome and congenital heart disease before cardiac surgery.
Methods: This study was conducted as a retrospective study by evaluating the records of all syndromic patients undergoing cardiac surgery at Children’s Medical Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran, from March 2011 to March 2017. Age, weight, height, weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), height-for-age z-score (HAZ), mortality and hospitalization rate in an intensive care unit (ICU) were recorded in these patients. The z-scores more than -1 were considered as normal, between -1 and -2 as mild malnutrition, between -2 and -3 as moderate malnutrition and below -3 as severe malnutrition.
Results: 35 (51.5%) patients were female and 33 (48.5%) were male. The mean age, weight, and height of these children were 26.9±24.9 months, 9.1±4.95 kg, and 79.55±17.95 cm, respectively. The mean of WHZ, WAZ, and HAZ in these children was -2.18+1.65, -1.95+2.25 and -1.22+3.11, respectively. Based on the values of WAZ, WHZ, and HAZ, 85.3%, 77.9% and 75% of patients have malnutrition (mild to severe forms, z-score less than -1). The most common cardiac defect was ventricular septal defect (VSD) accompanied by pulmonary arterial hypertension.
Conclusion: Considering the high prevalence of impaired nutritional status in these children and considering the effect of preoperative malnutrition on surgical outcomes, including mortality, assessing the nutritional status is much important. The adequate nutritional support in these patients leads to a reduction of the mortality, postoperative complications and morbidities.
