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The efficacy of topical prophylactic antibiotic in surgery for chronic otitis media
Khorsandi Mt, Karimi Yazdi A, Dabir Moghadam P ,
Volume 60, Issue 4 (7-2002)
Abstract

Background: The role prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with benefits obtained from the use of prophylactic antibiotics in surgery for chronic otitis media.

Materials and Methods: The current study was designed to evaluate the role of prophylactic antibiotics in the wound infection and outcome of surgery for chronic ear disease. It was the authors' impression that there was no difference between topical and systemic antibiotics in such surgery. Patients who met the inclusion criteria (n=193) were randomly assigned to a topical treatment group or a control group receiving only intravenous antibiotics for 1 dose intra operatively and 3 dose there after. Patients were followed post-operatively and observed for clinical evidence of infection, graft failur and hearing status.

Results: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival.

Conclusion: The use of prophylactic antibiotics in surgery for chronic otitis media can be recommended as an alternative method.


The effect of antibiotic irrigation of surgical Incisions in prevention of Surgical Site Infection
Mirsharifi S R, Emami Razavi S H, Jafari S, Bateni H,
Volume 65, Issue 11 (2-2008)
Abstract

Background: surgical site infection is one of the most common post operative complications alongside with sepsis, cardiovascular, pulmonary and thromboembolic complications. The development of surgical site infection is related to three factors: the degree of microbial contamination of the wound during surgery, the duration of the procedure, and host factors such as diabetes, malnutrition, obesity, immune suppression, and a number of other underlying disease states. The purpose of this study was to evaluate the effects of topical cephazolin in controlling infection of the site of surgery after non-laparoscopic cholecystecomy.

Methods: One hundred and two of patients referred to the outpatient clinic of Imam Khomeini Hospital from fall 2005 to fall 2006 non- laparoscopic cholecystectomy enrolled in a randomized clinical trial. All patients underwent the same procedure of anesthesia and surgery and they were randomly assigned into two groups of cases with irrigation of the site of surgery with 1g of topical Cephazolin prior to the termination of the operation- and controls. Cephazolin is a first generation cephalosporin which binds penicillin binding protein and is a potent cell wall synthesis inhibitor. The patients were followed up for six weeks for symptoms and signs of infection including discharge of the wound and presence of pain, warmness, swelling and erythema of the wound.

Results: There were no significant differences between two study groups regarding mean age, duration of operation, and sex. There was no significant difference in the incidence of infection of the site of surgery (11.8% in both groups with p=0.99) between two groups.

Conclusion: Analyzing the collected data confirms that prophylactic use of topical cephazolin was unable to decrease the risk of infection of the site of surgery in patients undergoing non- laparascopic cheolecystectomy.


The effects of topically applied tranexamic acid on reduction of post-laminectomy hemorrhage
Saberi H, Miri Sm, Poordel Namdar M,
Volume 68, Issue 9 (12-2010)
Abstract
Background: Topically applied tranexamic acid has been shown to decrease the amount of blood loss associated with major spinal surgical procedures. The aim of this study was to evaluate the effects of locally applied tranexamic acid in epidural space on post-laminectomy blood loss. Methods: One hundred patients who were scheduled to undergo laminectomy in Imam Khomeini Hospital in Tehran, Iran were enrolled in a clinical trial. Patients were divided into two groups of unilateral one level (n=50) and bilateral two level (n=50) laminectomy according to the extent of surgery. Each group was randomly allocated into two groups of tranexamic acid (n=25) and control (n=25). At the end of the operation, 250mg tranexamic acid, with volume of 5ml or 5ml of normal saline were poured on the site of surgery. The blood volume drained during first and second 24hr, and overall hemorrhage, plus the duration of post operative hospitalization were compared between the two groups. Results: The bleeding volume in the 1st 24hr was significantly less in tranexamic acid than control group (p=0.001). The bleeding volume in the 2nd 24hr was significantly less in tranexamic acid than control group (p=0.001). The hospital stay was less in tranexamic acid compared to control group (2.16±0.37 Vs. 2.96±0.89 days, p=0.001) respectively. Conclusion: Locally applied tranexamic acid in epidural space significantly reduces the amount of the 1st day, 2nd day and overall post-laminectomy blood loss, and duration of hospital stay. MicrosoftInternetExplorer4 Vs. 2.96±0.89 days, p=0.001) respectively.
Conclusion: Locally applied tranexamic acid in epidural space significantly reduces the amount of the 1st day, 2nd day and overall post-laminectomy blood loss, and duration of hospital stay.


The effects of topical metronidazole on post-hemorrhoidectomy pain: a brief report
Pourghassem J, Mahoori A, Akhbari P,
Volume 69, Issue 10 (1-2012)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oral metronidazole has been previously demonstrated to decrease postoperative pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole in reducing postoperative pain of hemorrhoidectomy.
Methods : In this double-blind, clinical trial forty 20- to 40-year old male patients were scheduled for hemorrhoidectomy under spinal anesthesia at the Imam Khomeini Hospital in Urmia, Iran from April to September 2010. The participants were assigned to receive topical metronidazole (n=20) or placebo (n=20). Pain intensity was assessed using a visual analog scale (VAS), the time of first narcotic request and morphine administrations were also recorded.
Results : The VAS scores were lower in metronidazole than the control group but this difference was not statistically significant, except after 24 hr post-surgically. Morphine administration in the first 24 hr was lower in the metronidazole group (P<0.05).
Conclusion: Although metronidazole could not prolong the time of first analgesic request, but application of metronidazole gel is associated with lower analgesic requirement.


Systemic side-effects of topical ophthalmic drops in a 17-year old boy candidate for deep viterectomy: a case report
Zahedi H, Maleki A,
Volume 70, Issue 4 (7-2012)
Abstract

Background: Drugs applied topically to the eye may be absorbed systemically to a substantial degree, with the potential to cause serious systemic side-effects. Children may be particularly vulnerable to systemic effects of topically applied agents as topical doses are often not weight-adjusted.

Case presentation: This article describes a case of serious systemic side-effect by the use of topical phenylephrine, tetracaine, tropicamide and atropine in a 17-year old boy candidate for deep viterectomy in Farabi Hospital in 1389. Following application of the aforesaid eye drops, the patient developed hypertension and subsequent loss of conciseness.

Conclusion: Several types of eye drops and their repeated use can lead to their systemic absorption and medical complications due to overdose. Strategies to minimize systemic absorption should be applied, including use of low concentrations of ophthalmic drugs, administration of one type of the drug, use of microdrops and punctal occlusion to minimize absorption via the nasolacrimal duct. While administering ophthalmic drops, one should take these precautions to minimize the systemic effects of the drugs to prevent subsequent complications.


Skin metastases in breast cancer: a review article
Behnaz Varaminian, Marzieh Ghalamkari , Tayeb Ramim, Masoumeh Roohaninasab ,
Volume 80, Issue 8 (11-2022)
Abstract
Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.

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