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Showing 28 results for Complications
Neuropsychiatric complications of 500 cases of hyperthyroidism
M Moetamedi , A Mofeed , M Mozdeh ,
Volume 56, Issue 4 (7-1998)
Abstract
Hyperthyroidism is often accompanied by diverse types of neuropychiatric complications. To demonstrate these complications we studied 500 hyperthyroid patients, who developed neuropsychiatric complications of hyperthyroidism for which other causes of these neuropsychiatric findings were carefully excluded. The patients were 15 to 65 years old (female to male ratio was 5:1), most of the cases were in third and fourth decades of life. Nervousness, tense dysphoria, insomnia and anxiousness were among the most common psychiatric complications, and tremor, hyperreflexia, thyrotoxic myopathy, thyrotoxic periodic paralysis were the most common neurologic complications. Therefore any physician, wether he or she is a general practitioner or a specialist must be aware of these diverse complications, because these neuropsychiatric complications can lead to the diagnosis of hyperthyroidism and treatment of these potentially serious complications.
Treatment of resectable distal rectal cancer with preoperative chemoradiation and sphincter saving surgery
R Omrani Pour , A Abasahl ,
Volume 58, Issue 1 (4-2000)
Abstract
To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y) with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm) and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66%) and good in 3 patients (33%). There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10%) and one case of partial rupture of anastomosis (10%). Complete pathologic response was achieved on one patient (6.6%) and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.
Influence of different factors on risk of complications of tubal ligation surgery: Study of 1780 women admitted to 13 hospitals in Tehran
Ramezan Zadeh F, Khalaj Abadi Farahani F, Sadat Hashemi Sm,
Volume 58, Issue 3 (6-2000)
Abstract
Tubal ligation is one of the most effective and reliable methods of contraception and of successful program of birth control in Iran. Present study was done to evaluate factors affecting risk of complications during tubal ligation surgery. We studied 1780 women that had tubal ligation in 13 hospitals in Tehran during the years 1993-95. Data on operation were collected by questionnaire and analyzed using logistic regression method. Risk of complications was increased in women had had operation after vaginal therapy, in luteal phase, after cesarean section and in follicular phase, respectively. Modified pomery, pomery and parkland methods of operation were ascendingly related to increased risk of complications. Age, history of pelvic pain, method of anesthesia, incision size and time of operation were not significantly correlated with complications. Frequency of complications was higher in women that had other procedures during surgery. We suggest that tubal ligation be done after vaginal delivery and by modified pomery method.
A survey of shunt complications in Shariati Hospital, Iran
Abdollah Zadeh Hosseini Sm, Naviafar D,
Volume 59, Issue 3 (6-2001)
Abstract

In this study we tried to assess the incidence rate of shunt complications and it's association with age, sex, location of shunt, duration of surgery, and so on. For this purpose in a prospective study, 82 cases of hydrocephalus after shunt insertion, during the period of two years (1375-1377) in Shariati hospital were selected and all the complications were evaluated. From the patients, 39 cases were female and 43 were male. The range for age was 15 to 73 years with mean age of 16.67 years (SD=22.77). In 22 cases the complications of shunt surgery were observed. Shunt complications in our patients were infection (8.6 percent) and mechanical failure (17 percent). The mean duration of time for onset of complications was 3.11±4.3 months. The complication rate at the beginning (under two) and the end of life was much higher. In trying to reduce the rate of shunt complications, it is necessary to define and understand the causes of these problems they often arise from multifictorial etiologies.


Omission of postoperative nasogastric tube in esophagectomy: a randomized clinical trial
Daryaei P, Vaghef Davari F, Mir M, Harirchi I, Salmasian H,
Volume 65, Issue 12 (3-2008)
Abstract

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.


Life expectancies and outcomes in extremely low birth weight neonates
, , , ,
Volume 66, Issue 4 (7-2008)
Abstract
Background: Much has changed in neonatal care for extremely low birth weight (ELBW birth weight <1000g) infants over the recent years in Iran, resulting in an increase in their survival rate. We determined neonatal survival and short-term morbidity rates among ELBW infants, and the correlation of these factors with mortality risk.
Methods: All single live-born ELBW babies delivered at Vali-e-Asr Hospital over a four-year period were identified. Data that were prospectively collected included: maternal age, prenatal and perinatal complications, antenatal steroid use, birth weight, gestational age, route of delivery, sex, need for resuscitation, APGAR score, need for mechanical ventilation, and complications including respiratory distress syndrome (RDS), sepsis, jaundice, intraventricular hemorrhage (IVH), necrotizing entrocolitis (NEC) metabolic and hematologic and cardiac disorders. Information was statistically analyzed and a probability value of <0.05 was considered significant.
Results: A total of 93 neonates were included in the study. The survival rate in the delivery room was 36.6%. The lowest birth weight was 400g, with a mean birth weight of 850.43(±136.48)g, and the lowest gestational age was 22 weeks. The mean gestational period was 28.31(±2.77) weeks. The most frequent complication after birth was RDS(69.89%) and the least frequent was NEC (6.4%). Short and normal gestation was observed in 44.08% and 48.4% of the neonates, respectively. There was a significant relationship between neonatal mortality and the need for resuscitation after birth, RDS and need for a respirator (p<0.05). Furthermore, there was significant increase in mortality among neonates with gestational age <30 weeks, birth weight under 750g and lack of steroids before birth (p<0.05).
Conclusions: To enhance perinatal and neonatal care and decrease the rate of preterm labor, improved standard resuscitation and increased administration of antenatal steroids and respirators are required.
Acute and subacute cardiac complications following radiotherapy in patients with left breast cancer
A Salari, M Aghili, E Nemati Pour, H Ranjbarnejad,
Volume 66, Issue 5 (8-2008)
Abstract
Background: Radiation to some parts of the heart is unavoidable in the therapeutic course of primary tumors in many kinds of cancer, including breast cancer. The aim of this study was to assess the frequency of acute and subacute cardiac complications following radiotherapy in patients with left breast cancer.
Methods: In this study, we enrolled 53 patients with left breast cancer who underwent mastectomy or lumpectomy between September 2005 and September 2006 in Imam Khomeini Hospital Complex, and subsequently underwent chemotherapy with anthracyclines (<450mg/m2) and Endoxan plus taxane/fFluorouracil followed by radiotherapy. In all patients, electrocardiography and echocardiography were performed before initiation of radiotherapy, immediately after radiotherapy and again three and six months later to check for radiotherapy-induced cardiac complications such as pericardial effusion, valvular lesions, left ventricular dysfunction, conduction system disturbances and other variables.
Results: Thirty-nine patients completed the follow-up period. Among these, 10 (25.6%) patients experienced cardiac complications following radiotherapy. Among these, mild pericardial effusion in seven (53.85%) patients, mild mitral regurgitation in three cases (23.08%) and Right Bundle Branch Block (RBBB) in two cases (15.38%) were the most common complications. We found no correlation between cardiac complication and tumor dose, dose fraction and type of chemotherapy protocol. We noted no cases of new or more serious complications, such as cardiomyopathies or coronary artery disease, nor any changes in ejection fraction by the end of the follow-up period.
Conclusion: In patients with left breast cancer, acute and subacute cardiac complications following radiotherapy are not serious and have no clinical significance. Further studies are needed for more assessments in this area.

Gastric pull-up versus pectoralis major myocutaneous flap techniques in hypopharyngeal cancer: comparison of complications
Rezaii J, Esfandiari Kh, Khalili Pooya J, Tavakoli H, Abdolrahman R, Salamati P, Abouzari M,
Volume 66, Issue 6 (9-2008)
Abstract

Background: Hypopharyngeal cancer usually presents with cervical mass, hoarseness, radiated otalgia, and dysphagea in the advanced stages. Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. The aim of this study was to evaluate the complications of pectoralis major myocutaneous flap (PMMF) and gastric pull-up (GPU) techniques to reconstruct a circumferential defect after laryngopharyngoeso- phagectomy.

Methods: We retrospectively reviewed the records of 64 patients who underwent radical surgery and reconstruction with either PMMF or GPU technique. Demographic characteristics, tumor location, proximal margin involvement, history of radiotherapy, presence of lymphadenopathy, cervical dissection, and postoperative complications such as fistula, anastomotic site stenosis, swallowing dysfunction, and stoma stenosis were compared between the two groups. Postoperative complications of the reconstruction methods were compared.

Results: A total of 64 patients, 43(67%) in GPU group and 21(33%) in PMMF group, were studied. The groups did not differ in demographic characteristics. The locations of the tumoral lesions were in larynx (n=7), proximal esophagus (n=5), posterior cricoid (n=5), pyriformis sinus (n=7), posterior wall (n=7), and miscellaneous (n=41). Six patients (6.3%) had proximal margin involvement, 19 patients (29.9%) had history of radiotherapy, 26 cases (40.6%) had lymphadenopathy, and 49 cases (76.5%) had cervical dissection. There was no significant difference between the two groups regarding stenosis or swallowing dysfunction rates, but fistula was seen lower following GPU compared with PMMF (p<0.001).

Conclusions: The GPU technique results in similar functional stenosis or swallowing dysfunction rates, but lower fistula compared with PMMF reconstruction.


Comparison of two methods for mechanical bowel preparation in elective operations of colon
Karimian F, Moghadamyeghaneh Zh, Aminian A, Pasha Meysami A, Fazely Ms, Kazemeini A,
Volume 67, Issue 4 (7-2009)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Polyethylene glycol (PEG) solution can induce complications when used as preoperative bowel preparation. The aim of this study was to compare two methods for mechanical bowel preparation in elective operations of colon.
Methods: In a randomized clinical trial, 129 patients elected for anastomosis of colon and referred to the surgical clinic of Imam Khomeini Hospital of Tehran between March 2008 and March 2009 were included. They were randomly allocated into two groups of PEG1 (1liter of PEG or 70gr plus 15 mg bizacodil, n=63) and PEG4 (4 liter of PEG), according to the way of bowel preparation and on the day before surgery, they received oral and IV prophylactic antibiotics and cleared solutions. In the morning of the surgery, they received their medication during 240 minutes. Then, they underwent anastomosic surgery of colon. The principle variables recorded were nausea, vomiting, flatulence, Na and K in the night before surgery, patients' and surgeons' satisfaction from bowel preparation and postoperative infection and leakage.
Results: The majority of the patients were male (62%). Nausea (28.57% vs. 98.48%, p=0.001), flatulence (36.51% vs. 95.45%, p=0.001), and vomiting (4.76% vs. 75.76%, p=0.001) were significantly lower in PEG1 and the patients' satisfaction were significantly higher (59.02% vs. 1.52%, p=0.001) Peroperative Na was significantly higher in PEG4 group (141.21±3.63 vs. 139.94±2.97mg/l, p=0.001) and serum K was significantly lower (3.55±0.25 vs. 3.76±0.21, p=0.001). Surgeons' satisfaction were significantly higher in PEG4 group (good to very good 72.73% vs. 43.54%, p=0.001). Postoperative infection of surgical site, anastomosis leakage and ICU admission were comparable between study groups.
Conclusions: Bowel preparation with 1 liter of PEG plus 3 bizacodile pills instead of 1 liter of PEG in patients undergoing elective anastomosis of colon is not only associated with lesser nausea, vomiting, flatulence, but also increases the patients' satisfaction and tolerance, lessens electrolyte disturbances and do not influence postoperative infection of surgical site and anastomosis leakage.


Repair of inguinal hernia: a comparison between extraperitoneal laparoscopy and Lichtenstein open surgery
Tavassoli A, Ghamari Mj, Esmaily H,
Volume 68, Issue 3 (6-2010)
Abstract
Background: The inguinal hernia is a common disorder in general surgery. Different methods have been described for repair of these hernias. In modern methods, synthetic mesh is used to cover the wall defect and the most known method is Lichtenstein surgical repair. The laparoscopic totally extra peritoneal procedure (TEP) is a newer technique of repairing hernia. The aim of this study is to compare the outcomes of totally extraperitoneal laparoscopic inguinal hernia repair versus Lichtenstein open repair in patients with inguinal hernia. Methods: Among 50 patients, 25 cases underwent Lichtenstein procedure and 25 patients underwent TEP technique for repairing primary unilateral inguinal hernia. Findings during the operation have been recorded and the 12-months follow-up of patients in different views was performed through a questionnaire and then the results were compared. Results: The operation duration, the rate of complications and frequency of recurrence were similar in two groups but the hospital stay, postoperative pain, chronic groin pain and the required time to return to normal activity were significantly lower in patients who underwent the TEP method compared to the patients who underwent the Lichtenstein technique (p<0.001, p<0.001, p=0.012, p<0.001, respectively). Conclusion: The TEP surgical technique can be recognized as a safe method with acceptable results for patients and has significant effects on improvement of patients’ quality of life after hernia repair. Suitable results of this surgical method are achieved when the surgeon goes through the learning curve.
 Surgical management of pilonidal sinus patients by primary and secondary repair methods: a comparative study
Haji Barati B, Ghafuri A,
Volume 68, Issue 9 (12-2010)
Abstract
Background: Gross difference in return to work exists in pilonidal sinus patients operated by primary and secondary repair. This survey was to evaluate the results of surgical management of pilonidal sinus with primary or secondary closure.
Methods: In a randomized clinical trial, patients with pilonidal sinus referring to the surgical clinic of Shariati Hospital in Tehran, Iran between March 2007 and March 2009 were underwent either excision with midline closure (primary, n=40), or excision without closure (secondary, n=40). The recorded outcomes were hospital stay, healing time, time off work, postoperative pain, patient's satisfaction and the recurrence rate.
Results: Majority of the patients were male (87.50%). There was no significant difference in the hospital stay. Time off work (8.65±1.73 Vs. 11.53±2.33 days, p=0.001) and healing time (3.43±0.92 Vs. 5.3±0.79 days, p=0.001) were shorter in primary group but, there were no significant differences in hospital stay and number of visits. Intensity of postoperative pain in the 1st (37.75±6.5 Vs. 43.63±5.06, p=0.001), 2nd (26.75±6.66 Vs. 34.63±5.48, p=0.001), 3rd (18.25±6.05 Vs. 27.88±6.88, p=0.001), and 7th (8.45±3.85 Vs. 17.88±6.19, p=0.001) days were lower in primary closure group. There was not significant difference in complication rates in groups. Patients' satisfaction was higher in primary group (4.15±0.53 Vs. 3.6±0.5, p=0.001).
Conclusion: According to this study excision and primary closure is the preferred procedure in patients with pilonidal sinus. It has the advantages of shorter time off work earlier wound healing, lesser postoperative pain, higher patients satisfaction and comparable complication and recurrence rates with excision and open wound.


Drug-induced complications of anti-tuberculosis drugs in HIV patients
Rasoulinejad M, Bouyer M, Emadi Kouchak H, Hasibi M, Mollazadeh N, Moradmand Badie B,
Volume 68, Issue 10 (1-2011)
Abstract
Background: Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment.
Methods: A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected.
Results: In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus.
Conclusion: The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.


Factors related to extubation failure and post pulmonary complications in intracranial surgery in 254 patients: a brief report
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.


Long-term results of open gastric bypass with Roux-en-Y method for morbid obesity: brief report
Ghodratolah Maddah , Hossein Shabahang , Mohammad Reza Barband , Abbas Abdollahi , Alireza Tavassoli ,
Volume 72, Issue 9 (12-2014)
Abstract
Background: This study aims to evaluate the outcomes and late complications of open Roux-en-Y gastric bypass surgery in the treatment of morbid obesity. Methods: Over a 15 year-period between May 1997 and May 2012, we reviewed our experiments with 39 patients who underwent open gastric bypass for morbid obesity. The weight of the patient and surgical complications were recorded. Ideal weight, body mass index, weight loss and excess weight loss were calculated. Results: The follow up period ranged from 6 to 180 months with a mean of 100 months after operation. Average weight loss was 3.9 and 0.28 kg per month during the first and second years after operation weight loss was slower from the third year on-wards. Weight loss generally was stabilized between 12 and 18 months after operation. Only one patient (2.6%) had a weight loss failure criterion. Concomitant condition ex-isted in 14 patients (48.2%) of our series. These included hypertension in 3 cases (10.3%) that was resolved in 100%, diabetes mellitus in 4 (13.7%) that was resolved in 75%, cholelithiasis in 7 cases (24.1%) that was resolved by cholecystectomy during the operation. There was no early postoperative death. Early complications occurred in 2 patients (5.1%), including pulmonary embolism (2.6%) and gastrointestinal bleeding (2.6%). The late complications occurred in 7 patients (17.9%) involved 2 patients with anastomotic stricture at the gastrojejunostomy (5.1%), One patient with symptomatic cholelithiasis (2.6%), three patient with anemia (7.7%), and one patient had Wernicke ’s disease who died of this complication (2.6%). Conclusion: The results of the study showed that the open Roux-en-Y gastric bypass surgery is an effective procedure in the treatment of morbid obesity with minimal late complications.
Prospective evaluation of outcome of karydakis flap for sacrococcygeal pilonidal disease
Amir Keshvari , Mohammad-Sadegh Fazeli , Alireza Kazemeni , Alipasha Meisami , Mohammad-Kazem Nouri-Taromloo,
Volume 72, Issue 12 (3-2015)
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.
Evaluation of side effects of ondansetron in pregnancy: a descriptive case-series study
Masoomeh Mirzamoradi , Zahra Heidar , Parichehr Kimiaee , Masoomeh Saleh , Sepideh Ashrafivand ,
Volume 73, Issue 1 (4-2015)
Abstract
Background: Ondansetron is a 5-hydroxytryptamine receptor antagonist which is a highly effective antiemetic for postoperative and chemotherapy induced nausea and vomiting. It is an off-label drug to treat nausea and vomiting of pregnancy but availa-ble data about its safety is limited. In this study our purpose was to evaluate neonatal outcomes in women who received this treatment. Methods: This study is a descriptive retrospective case series study, included 22 preg-nant women who treated with ondansetron due to repeated nausea and vomiting unre-sponsive to our center's protocol, at Mahdiyeh Hospital, Tehran, Iran from May 2006 to September 2014. We investigated neonatal factors including: gestational age at birth, stillbirth, neonatal birth weight, apgar score, need to NICU admission and major birth defects. Results: The outcomes of 22 pregnancies and 22 newborns are presented here. We had two twin pregnancies and two abortions. Ondansetron was initiated in 18 cases (72%) on average gestational age of 9 weeks, during organogenesis. In 8 cases (32%) on-dansetron continued till third trimester of pregnancy. In primary evaluation, all the pa-tients had ketonuria, 15 cases (60%) had hypokalmia (K< 3.5), 3 cases (12%) had ab-normal TSH that all of them were hyperthyroidism and 5 cases (20%) had abnormal liver function test (LFT) Three patients (12%) had positive urine culture, one patient had hypercalcemia and one patient who was known a case of hypocalcemia had low serum calcium. The mean time of admission due to hyperemesis gravidarum (HG) was 5 days (2-10 sd=1.92). In this study we had only one preterm birth and the mean neo-natal birth weight was 3110 gram, one newborn was low birth weight due to preterm birth. Finally none of newborns had low apgar score, no one needed to NICU admis-sion and no congenital anomaly was seen in neonates. Conclusion: Ondansetron taken during pregnancy was not associated with increased risk of adverse fetal outcomes.
Adverse pregnancy and neonatal outcomes in polycystic ovary syndrome women
Roshan Nikbakht , Mahvash Zargar , Zeinab Barekati , Razieh Mohammad Jafari , Nahid Shahbazian , Mojgan Barati ,
Volume 73, Issue 11 (2-2016)
Abstract

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorders in reproductive age women. These women confer with complications of pregnancy such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and neonatal complications such as small for gestational diabetes (SGA) are more prevalence in women with PCOS. The aim of this study was to evaluate the incidence of complications associated with PCOS in pregnant women.

Methods: This was an observational and prospective study which recruited 205 pregnant women with PCOS from Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences (AJUMS) between 2013 and 2014. Inclusion criteria were women with PCOS and gestational age over 20 weeks. The demographic and clinical variables including mother's age, body mass index (BMI) and conditions of pregnancy including pregnancy-induced hypertension, preeclampsia, gestational diabetes and overt diabetes and neonatal complications such as preterm labor (PTL), SGA and intrauterine fetal death (IUFD) were recorded.

Results: The prevalence of hypertension disorders, preeclampsia, gestational diabetes and overt diabetes were observed in 44 (21.5%), 18 (8.8%), 29 (14%) and 22 (11%) patients, respectively. The history of familial diabetes was shown in 28 patients (13.6%). In addition, the history of pregnancy induced hypertension was reported in 25 patients (12.1%). Only 6 patients (2.9%) had history of gestational diabetes. Among neonatal complications due to PCOS, SGA with 15.3% and then PTL with 12.6% had highest prevalence. IUFD was shown only in 2 patients.

Conclusion: Pregnant women with PCOS are at the higher risk for pregnancy and neonatal complications. Specifically, these women should be evaluated for pregnancy induced hypertension during pregnancy than others.


A uterine perforation during laparoscopic cholecystectomy: case report
Atiyeh Vatanchi , Leila Pourali , Mona Jafari ,
Volume 76, Issue 2 (5-2018)
Abstract
Background: Laparoscopy is an acceptable procedure for cholecystitis in pregnancy. Laparoscopic complications during pregnancy can be unique. Uterine perforation is a rare complication during laparoscopy of pregnant women. Acquaintance with this complication can help surgeons and gynecologist to manage these patients properly. We will report a case of uterine perforation during laparoscopy.
Case presentation: Our patient was a 24-year pregnant woman with gestational age of 28 weeks. She had nausea and vomiting and right upper quadrant tenderness, she was admitted in surgery ward on January 2017 in an academic hospital in Mashhad and candidate for laparoscopic cholecystectomy with diagnosis of cholecystitis. Her fundal height was 28 centimeters. Laparoscopy was done with Hasson technique and three punctures. During abdominal trocar insertion uterine perforation occurred. Amniotic fluid leaked in the abdomen. Perforation repaired immediately and then cholecystectomy was done. Fetal heart rate was normal. After surgery according to stable vital signs and absence of bleeding and contraction, the patient was transferred to the midwifery department. The patient received one course of betamethasone for fetal lung maturation. Antibiotic therapy initiated. During the hospitalization, the patient was monitored daily for vital signs (fever and tachycardia), uterine contraction, vaginal bleeding and vaginal bleeding. Daily fetal heart monitoring was performed. After close prenatal care cesarean section was done in 38 weeks of pregnancy and a healthy baby was born with appropriate Apgar score.
Conclusion: Laparoscopy in pregnant women is usually safe. Pregnancy-specific complications such as uterine injury are not common, but with a series of precautions before and during surgery. These complications can be reduced. Uterine perforation during laparoscopy if properly managed is usually not associated with significant risk.

a case of acute leukemia with multiple complications due to leukemia and it's treatment: case report
Fatemeh Rajabipour, Negar Sajjadian ,
Volume 76, Issue 4 (7-2018)
Abstract
Background: Acute leukemia is one of the most common types of childhood malignancies and one fourth of malignancies in this age group is acute leukemia. Acute leukemia may be myeloid or lymphoid. Acute lymphoblastic leukemia is characterized with abnormal proliferation of lymphoid cells and symptoms related to this are acute and if disease is not treated appropriately, it progresses rapidly and end up to death. Diagnosis of these types of malignancies is easily made with evaluation of bone marrow and peripheral blood cells by an expert hematologist. One of the primary sites of leukemic involvement in childhood is oral cavity which is caused by infiltration of leukemic cells in this area. This causes signs and symptoms, for instance, oral lesions gingival hemorrhage and swelling.
Case presentation: We present a 13-year-old girl who was referred to local physician due to toothache and gingival lesions. Some medications were prescribed for her without any improvement. Then excision of this painful gingival lesion was done and diagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and start of appropriate medical therapy, patient developed many different complications of acute lymphoblastic leukemia and its related therapies. What make this presented case as an outstanding and interesting one is the mentioned complications which were more significant with multiple organ involvement in comparison with similar cases. These complications were treated by appropriate managements.
Conclusion: With new advance in treatment of ALL, survival rate of patients is increased but unfortunately morbidity rate is significant. These complications may be managed by appropriate therapies and close follow-up.

A review on electrical burn and its complications: review article
Kamran Aghakhani , Maryam Ameri ,
Volume 76, Issue 6 (9-2018)
Abstract
Although electrical energy is one of the best and cleanest energy sources, the proper protection and utilization of it, always and everywhere is problematic. One of the most important problems is electric shock and the dangers that can sometimes be lost in the lives of people. When a body or part of it is completely located in a strong power supply field or a contact with a device that is connected to a high voltage power supply, the person experiences an electrical burn. Electrical burn injuries account for about 5% of beds in large burn centers. The type of complications due to electrical burns varies according to the location of the current flow, its severity and tissue resistance. But usually the most severe physical and emotional complications are in the upper arms and legs of the body. While electrical injuries primarily result in burns, they may also cause fractures or dislocations secondary to blunt force trauma or muscle contractions. In high voltage injuries, most damage occur internally. On the other hand, psychological trauma and subsequent disability and unemployment problems affect the lives of electric burn victims. Understanding and managing the short-term and long-term complications of electrical burns is important in addition to proper and timely treatment of the injured person. Electric current with a high voltage of 1000 Volts causes a wide and deep burn which may not be estimated exactly at the onset of a visit by the doctor  and also patient himself. So, it should be mentioned the issues legally, to the patients and their relatives, in terms of the severity of lesions and the complications of probable amputation. On the other hand, because prevention is always better than cure, so appropriate information through the mass media can reduce the number patients and their complications. In this review study, introducing various types of electrical burns and the reported statistics, various complications of electrical burn are discussed. Awareness of the incidence of electrical burns in the population and its various complications can help to plan and manage the problems of electric burn injuries, as well as adopting strategies to prevent these incidents.

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