Showing 10 results for Local
Sedighi S, Mohagheghi M, Memari F, Jahangir R, Mousavi Jarrahi A, Montazeri A, Sedighi Z, Mostaghimi M Tehrani, Zanganeh M,
Volume 64, Issue 7 (8-2006)
Abstract
Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma
Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1) Cisplatin and continuous infusion of 5FU and Epirubicin (ECF), and 2) Cisplatin and continuous infusion of 5FU with Docetaxel (TCF). Reduction in tumor mass, overall survival (OS), time to progression (TTP), and safety were measured outcome.
Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass) was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002) and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0) resection had done in two of ECF and six of TCF tumors (p=0.015). Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups.
Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.
Noyan Ashraf M.a, Mirghasemi A.a, Peiravy Sereshke H,
Volume 64, Issue 10 (10-2006)
Abstract
Background: We report a case with apparent resistance to local anesthetics. While regional anesthetics failure are often attributed to technical failure, the clinical presentation and medical history of this patient suggests a true resistance to local anesthetics.
Case report: A 28 years old man was scheduled for elective orthopedic surgery for right sided tibial bone fracture, and decision of spinal anesthesia was made. There was a questionable history of multiple prior episodes of local anesthetic unresponsiveness (Interscalan block, local infiltration for lipoma resection and dental surgery). Spinal anesthesia was performed and sensory or motor blockade was not obtained despite any evidence of technical problems. The surgical procedure performed under general anesthesia and skin analgesia (local infiltration of lidocaine 2% and bupivacaine 0.5% to forearm), did not achieve, the day after surgery.
Conclusion: While the failure rate of spinal anesthesia has been shown range from 4 to 13% and is often attributed to technical failure, this particular case showed a true resistance to local anesthetics.
Keshvari A, Jafari- Javid M, Najafi I, Chaman R, Nouri Taromloo Mk,
Volume 66, Issue 7 (10-2008)
Abstract
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Background: Chronic peritoneal dialysis
is a safe method for the treatment of end-stage renal failure. Worldwide,
patients on chronic peritoneal dialysis constititute approximately 15%
of the total number of patients on dialysis. In Iran, very few people have access
to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This
lack of access is primarily due to the high occurrence of mechanical
complications. Improving catheterization procedures is an important way to
extend the use of peritoneal dialysis in Iran. Thus, a prospective study was
implemented to evaluate the outcome of a new laparoscopic technique for the insertion
of peritoneal dialysis catheters under local anesthesia.
Methods: A
total of 115 catheters (two-cuff, swan-necked, coiled) were
inserted into the peritoneal cavity of 109
patients with end-stage chronic renal failure during a 16-month
period. The method of insertion was a two-port laparoscopic technique with
local anesthesia and sedation. All patients were followed for 12
to 28 months. We prospectively evaluated mechanical
and infectious complications and survival rates of the catheters.
Results: The
average age of the patients was 51.5 years (range: 15-84
years) 54.8% of these patients were female. The overall
one-year and two-year catheter survival rates using this approach were 88%
and 73%, respectively. Event-free catheter survival
was 35%. The most common infectious and mechanical
complications were peritonitis in 52
cases (45.2%) and temporary dialysate leakage in 10
cases (8.7%) respectively.
Conclusion: Laparoscopic insertion of
peritoneal dialysis catheter with local anesthesia is a safe and simple
procedure, giving reasonable rates of catheter survival and complications.
Farnaz Amouzegar- Hashemi, Alireza Alaleh, Ali Kazemian, Peiman Haddad,
Volume 67, Issue 12 (3-2010)
Abstract
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Background: Breast conservative therapy is associated with
similar outcomes in comparison with mastectomy. The
aim of this study is assessment of local recurrence rate and related risk
factors in patients who have been treated with radiotherapy after conservative
surgery for breast cancer.
Methods: This is a cohort study which data of all breast
cancer patients who have visited in follow up clinic in radiation oncology
department of cancer institute of Imam
Khomeini Hospital
complex in Tehran, Iran,
during years 2007-2009 were collected. All
of the patients were investigated for local recurrence and the possible risk
factors.
Results: Two hundred and seventy seven patients have entered
the study and all have followed for at least one year since data entry. Median
follow-up time from the start of radiotherapy were 35
months (12-148 mo).
We had seven cases (2.5%)
with local recurrences (2.5%)
which most of them occurred in first year after treatment. Because
of low rate of recurrence none of the variables such as margin and nodal status
has significant correlation with local recurrence which this should be due to
small number of patient and short time of follow up.
Conclusions: At
median follow up of 35 months from the beginning
of radiation therapy, local recurrence rate was 2.5% which
is similar to the literature. We recommend to follow a
larger group of patients for longer times to estimate recurrence risk after breast
conservative therapy.
Mehdi Moghtadaei , Hossein Farahini , Hamid Reza Faiz , Farzam Mokarami , Razieh Nabi ,
Volume 71, Issue 7 (10-2013)
Abstract
Background: Pain is one of the greatest concerns of patients undergoing total knee arthroplasty (TKA) which is severe and intolerable within 72 hours post-surgery. Appropriate pain management is a key factor in patient's early mobilization, launching physiotherapy, less hospital length of stay and more importantly, patient's satisfaction. New studies with the infiltration of combined analgesic agents peri and intra-articularly has shown encouraging results in pain reduction, good clinical outcome and patient's satisfaction. The purpose of this study was to compare the analgesic effect of locally infiltrated analgesia (I) compared with single injection femoral nerve block (F) and its impact on pain relief, patient's satisfaction, morphine consumption and clinical outcome.
Methods: This research was a double-blind randomized clinical trial on 36 consecutive patients undergone TKA divided into group (F) in which the ipsilateral femoral nerve in the inguinal area was blocked by a single injection of 20 ml ropivacaine (10 mg/ml) and group (I) which a combination of ketorolac, ropivacaine and epinephrine was injected peri and intra-articularly on the knee during TKA. Pain intensity measured by visual analog scale (VAS), clinical outcome (based on range of motion), morphine consumption and patient's satisfaction of pain management after TKA were compared between the two groups.
Results: Pain intensity score (VAS) and Morphine consumption were statistically less in group I than group F during the first 6 hours and 24 hours post surgery respectively (P< 0.05) however, group F had 12-hour VAS score of 5 which was less than group (I) by 1 grade in pain scale (VAS) (P< 0.05). Other parameters were not statistically different in the two groups and patients' response to our pain management protocols proved to be satisfactory in both groups.
Conclusion: Lower level of pain and morphine consumption in group (I) during the first 24 hours post-surgery in contrast to group (F) and its ease of use by a surgeon intra-operatively, introduce local infiltration analgesia as an effective method to decrease the patient's pain and improve patient's satisfaction in early post-surgery period after total knee arthroplasty.
Amir Keshvari , Mohammad Sadegh Fazeli , Alireza Kazemeini , Alipasha Meysamie , Mohammad Kazem Nouri Taromlou,
Volume 71, Issue 10 (1-2014)
Abstract
Background: Colorectal carcinoma is considering as a curable disease. Treatment of recurrent cases is hard and sometimes impossible. Evaluation of the rate and affecting factors of recurrence in each hospital would help to decreasing recurrent cases. The aim of this study is evaluation of the rate, clinical and pathologic features, and outcome of recurrent colorectal carcinoma in a referral teaching hospital in Tehran.
Methods: Clinical data of 166 curative resections of colorectal carcinoma who were operated between Mehr 1384 and Mehr 1388 (between 23 September 2005 and 23 September 2009) in Imam Khomeini Hospital and were accessible for follow up was collected. Follow up data was collected prospectively up to Farvardin 1391 (19 April 2012). Forty nine recurrences were happened in this period. We compared recurrent and non-recurrent cases for different variables
Results: Average age of the patients was 53.5 years, and 47% of them were female. The median time to the diagnosis of recurrent disease was 12 months (range 1 months to 54 months). There were no significant differences between recurrent and non-recurrent patients about age, sex, sub-site of the tumor and sub-type of primary operation. Rate of overall recurrence, local recurrence and distant metastasis were 29.5%, 15.7% and 12.1% respectively.
Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%). Rate of curative re-resection was about 25%. Overall survival of the recurrent patients who underwent surgery was better than who underwent chemo or radiotherapy (66.7% vs. 56.8%). Median survival time of recurrent patients after primary surgery was 28 months, and after diagnosis was 12 months (9.28- 14.72,95% CI).
Conclusion: In this study the rate of overall recurrence was 29.5%. Local recurrence rate was higher in colon cancer (16.44% vs. 15.05%) but distant metastasis rate was higher in rectal cancer (12.9% vs. 10/96%).
Kambiz Javadzadeh Siahkelrodi , Shahpour Shoja, Karim Naseri, Farzad Sarshivi, Shahrokh Ebnerasouli, Mohamad Aziz Rasouli , Shaho Shoja ,
Volume 79, Issue 7 (10-2021)
Abstract
Background: Bier block is a reliable technique used in extremity surgeries. Typically, angiocatheters are palced in the distal portion of the extremity that is going to be operated. Although, it is not the case in every operation. Therefore, determining the effectiveness of the local anesthetic injection site on the quality of the upper-extremity block can be helpful.
Methods: In this double-blinded randomized clinical trial that took place in Kowsar Hospital (Sanandaj, Iran) at 2020, 60 patients after complete monitoring and sedation were assigned randomly into proximal bier block (32 in experimental) and distal bier block (28 in control) groups. 10ml/kg Ringer serum was prescribed for patients in both groups on the non-surgical hand. Depending on the patients’ placement in either group, an angiocatheter (22 or 24) was attached to the ante-cubital area (proximal bier block group) or on the back of the patient's hand (distal bier block group). Respectively, after blood was drained by a Smarch band from the extremity that was to be operated, the tourniquet was inflated up to 150mmHg above the patient’s systolic pressure and the smarch band is untied from the hand. For every patient regarding the group they were assigned, 3mg/kg lidocaine 0.5% was administered through an angiocatheter. After 5 minutes, the depth of patient's anesthesia and pain intensity were measured. Sensory and motor recovery was assessed every 10 minutes after surgery. Patient satisfaction with anesthesia was measured after the surgery and characterized by excellent, good, moderate (pain relief), and unsuccessful (need for pain medications) indicators. In case insufficient depth was reached, intravenous Remifentanil was injected.
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Results: According to the results of the chi-squared test, there were no significant differences in gender distribution (p=0.063), anesthesia class type (p=0.964), type of surgery (p=0.694), anesthesia satisfaction (p=0.578), sensory block of hand (p=0.529), motor block of hand (p=0.059), pain intensity (p= 0.634), pain relief medication requesting (p=0.755) and also body mass index (T-test used P=0.099) variables comparing both groups together. Additionally; according to the T-test results no significant differences were reported in the mean systolic pressure, mean diastolic pressure and mean heart rate variable in designated times.
Conclusion: There is no significant difference between the two groups. Therefore, using a distal Bier block can be an alternative if needed.
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Masoomeh Tabari , Marjaneh Farazestanian, Helena Azimi, Maryam Esmaeilpour, Malihe Hasanzadeh Mofrad ,
Volume 79, Issue 9 (12-2021)
Abstract
Today surgery is supposed as the cure for many diseases and the fear of post-operation pain burdens stress over the patients. Postoperative pain can, especially if severe, complicate the patient's condition and may lead to chronic postoperative pain. post-operation pain control is effective in the recovery process, hospitalization period and patients’ satisfaction. Insufficient post-operation pain control increases complications and care costs. Local analgesia is one of the components of multimodal postoperative. analgesic protocol to control pain. Local analgesia technique is a simple, accessible and feasible method for various surgeries. The opioid analgesics to control post-operation pain are associated with some complications such as opium addiction, nausea and vomiting, late return of bowel function and social costs. This review study aims. to review previous studies on the effect of injection of analgesic agents in the surgical incision in post-operation pain control. This is a Narrative review study. to related scientific documentaries a search was conducted in Persian and English using the keywords of local injection of the incision site, wound infiltration with analgesic agents and post-operation pain control in Google scholar, PubMed and Scopus database during the years 2000 to 2020. The obtained articles included systematic reviews, Meta-analyses and randomized clinical trials (RCT). We reviewed studies that had utilized single-dose injection of analgesic agents in surgical incisions at the end of surgery to control post-operation pain. A total of ten studies were reviewed. There were 4 studies in the field of laparoscopic gynecological and non-gynecological surgeries, three studies in the field of laparotomy and three review studies. injection of analgesic agents in the surgical incision to control post-operation pain is easily available and does not necessitate any special skill. On the other hand, it is a safe method without further complications and does not increase the duration of surgery. Regardless of the differences in various studies and the kind of analgesic agents, a general reduction in pain severity and consumption of opioid and non-opioid analgesic agents were observed using the injection of analgesic agents in surgical site incision.
Malihe Hasanzadeh, Marjaneh Farazestanian, Afrooz Azad, Parnian Malakuti, Maryam Esmaeilpour,
Volume 80, Issue 4 (7-2022)
Abstract
Background: Aggressive angiomyxoma is a rare mesenchymal tumor with extensive local invasion. It often presents with a lump in the perineal area and pelvic. Since it often does not involve adjacent organs such as the urethra and anus, does not cause obstructive symptoms. Its incidence is 6 times higher in women than men. This tumor grows slowly and has a slight tendency to metastasize. However, the rate of local recurrence is high. MRI is the most widely used diagnostic method. Ultrasound and CT scan are also used for diagnosis. Due to the rarity of this tumor, it is difficult to diagnose before surgery and pathology assessment. Due to the penetrating nature of the tumor and the lack of a clear capsule, incomplete surgical resection is common. Local recurrence is common even after complete mass resection. Therefore, patients need a long follow-up. The main treatment is surgery but non-surgical interventions such as hormonal therapy, radiotherapy, arterial embolization, etc. have been associated with variable success rates.
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Case Presentation: A 54-year-old female patient presented with a vulvar mass in February 2021. The patient mentioned that the mass had existed for ten years and had increased in size in the last two years. After discussion on the tumor board, she underwent surgery. The pathology of the mass was reported to be aggressive angiomyxoma. The patient was treated with a GNRH agonist after surgery. The patient is currently under follow-up and has not had a recurrence so far (March 2020).
Conclusion: Aggressive angiomyxoma is a rare mesenchymal tumor. It has extensive local invasion and a high recurrence rate, but distant metastasis is rare. Estrogen receptors or Progesterone receptors are commonly positive in aggressive angiomyxoma. The best treatment for aggressive angiomyxoma remains unknown. Extensive local resection of the tumor has been reported as an important therapeutic measure. In cases of mass recurrence, reoperation and hormone therapy have been effective. It is important for gynecologists to consider this tumor as a differential diagnosis when dealing with vulvar masses.
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Fariba Zarei , Mohammadreza Sasani, Banafsheh Zeinali-Rafsanjani , Mahdi Saeedi-Moghadam ,
Volume 80, Issue 7 (10-2022)
Abstract
Background: Fine needle aspiration biopsy (FNAB) is usually used to distinguish the malignant and benign nodules. Applying a biopsy needle evokes a sense of fear and pain in the patients. Although some studies refute the usefulness of local anesthesia (LA) prior to fine needle aspiration biopsy, it is still debatable. This prospective cross-sectional study intended to evaluate the effect of LA prior to fine needle aspiration biopsy on pain and anxiety considering nodule size.
Methods: Amongst the patients who were referred to Shiraz Shahid Fagihi Hospital for Thyroid fine needle aspiration biopsy from August 2017 to January 2018, 114 patients participated in this study. LA was performed for 41 patients, and 73 underwent the thyroid nodule fine needle aspiration biopsy without LA. Patients' pain and anxiety were scored using the visual-analog-score and Spielberger anxiety scale. The nodules were categorized into five groups. Pain and anxiety of patients were compared considering their nodule sizes to assess the effects of LA in the reduction of pain and anxiety considering the nodule size.
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Results: The patients undergoing LA had a mean age of 44.69 years old and average body mass index (BMI) of 26.7, the patients who performed thyroid nodule fine needle aspiration biopsy without LA had a mean age of 48.17 years old with an average BMI of 26.0. The patients with the maximum nodule size of<10 mm, experienced more pain during the fine needle aspiration biopsy without LA, but there was no significant difference between the S/T-anxiety of these patients. There was no significant difference between the pain and anxiety scores of the patients with larger nodules.
Conclusion: The more pain experienced by the patients with the smallest nodules can be attributed to the need for more needle manipulation due to the small nodule size and less precision while piercing the needle into the nodule. Thus, it can be suggested that in patients with a small nodule size, less than 10mm, usage of LA prior to fine needle aspiration biopsy can reduce the pain significantly.
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