Tehran University Medical Journal

Background: The benefits of aspirin have been proven by repeated examinations, especially in secondary prevention in cardiac infarction, stroke, and after interventional angiography and stent insertion.
Methods: This is a retrospective study on all patients who underwent non-cardiac surgeries between June 2005 and March 2013 in Ghaem hospital in Mashhad and aspirin continued due to many reasons. Most frequent surgeries included laparoscopic appendectomy and cholecystectomy. Information such as bleeding and its amount both during surgery and post-operative, hematoma after surgery, requiring re-operation due to bleeding and cardiovascular events in hospital were recorded and analyzed. Moreover, all patients were followed within one month after discharge from hospital to check whether any cardiovascular events had been happened. Furthermore, bruising in the skin, and bleeding after discharge were evaluated. Data were analyzed using SPSS Version 16 (SPSS, Chicago, IL, USA).
Results: One hundred seventy patients enrolled in the study and all of them underwent general anesthesia. Of all patients 37.06% were male and 62.94% were female. The mean age was 52.78±5.01 years. Majority of operations included laparoscopic cholecystectomy (41.62%). Also in most of the patients (58.38%) surgery were emergency and discontinuation of aspirin were impossible. 91.37% of patients were taking less than 80 mg aspirin per day. Mean bleeding amount during surgery was 100 ml. 13 patients (6.59%) who undergo laparoscopic cholecystectomy and one patients in appendectomy group had bleeding more than 110 ml due to inadequate artery ligation and they underwent conversion to open surgery and bleeding were controlled successfully. Other eight patients (4.06%) treated conservatively without need to conversion to open surgery. In 7.61% of patients, ecchymosis happened which were healed within one month. No patient underwent reoperation due to post-operative hemorrhage. No vascular event and hematoma had been reported during one month follow up after surgery.
Conclusion: Continuing aspirin in perioperative period of non-cardiac surgeries were without additional risk of bleeding and it also helped to reduce risk of vascular evets post-operatively.

Background: Recently, the surgical methods are used in patients with anterior cruciate ligament rupture and have been associated with successful results. There are different results in the term of using of the surgical methods for anterior cruciate ligament that often is associated with some complications such as infection, static laxity, remaining the pain, need to recurrence surgery, and limitation in the range of motion. Therefore, in this study, we aimed to compare outcomes of anterior cruciate ligament reconstruction with the fixed loop and the adjustable loop.
Methods: This cross-sectional study was done on 60 patients undergoing anterior cruciate ligament reconstruction referred to Kashani Hospital of Isfahan, Iran, from March 2017 to February 2019. Also, this study was approved in the Isfahan University of Medical Sciences, Isfahan, Iran. 30 patients were assigned to a fixed loop and 30 patients under the adjustable loop method. Postoperative outcomes were compared with the fixed loop group and the adjustable loop group.
Results: The frequency of static laxity below 8 mm in the fixed loop group was 83.3% and the frequency of static laxity below 8 mm in the adjustable loop was 76.7%. There was no significant difference between the fixed loop group and the adjustable loop group based on static laxity. Also, no infection was seen in the fixed loop group and the adjustable loop group. There was no significant difference between the fixed loop group and the adjustable loop group in terms of range of motion and knee score before and after surgery. After surgery, 96.7% of the fixed loop group and 86.7% of the adjustable loop group returned to normal activity. There was no significant difference between the fixed loop group and the adjustable loop group in terms of return to normal activity and satisfaction.
Conclusion: Using the fixed loop is effective, useful, and with low-complication for the patients with anterior cruciate ligament and also using the adjustable loop grafts is effective, useful, and with low-complication for the patients with the anterior cruciate ligament rupture.

Background: Nausea and vomiting is one of the most common complications after the strabismus surgery. In this study, we evaluated the efficacy of atropine versus ondansetron administration on the incidence of postoperative nausea and vomiting and duration of recovery stay in patients undergoing this procedure.
Methods: In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.
Results: There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.
Conclusion: It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.

Background: Cervix insufficiency is diagnosed based on a previous history of pregnancy loss in the second trimester, followed by painless cervical dilatation or premature rupture of the fetal membranes. Abnormal cervical tissue structural appears to be the cause of this complication. There are no diagnostic methods for cervical insufficiency before pregnancy, but magnetic resonance imaging (MRI), hysterosalpingography, and ultrasound can detect uterine anomalies that are risk factors for cervical insufficiency. Cerclage is known as a common procedure for prevention of the preterm labor, caused by cervix insufficiency. This study aimed to evaluate the prevalence of cerclage and it’s complications and prognosis based on the patient’s age, history of cervical insufficiency, history of preterm labor, history of miscarriage, curettage, and cervical and vaginal abnormalities.
Methods: A retrospective cohort study was conducted, including 65 patients, from March 2012 to March 2018, in Valiasr Hospital, Tehran, Iran. Data including the age, history of cervical insufficiency, history of abortion, history of cervix surgery and curettage, gestational age, presence of vaginal and cervical anomaly as well as complications such as bleeding and severe cervical pain and prognosis of cerclage were extracted.
Results: In our study, 65 women who undergone cerclage were evaluated, the mean age of the participants was 28.4 years. Abortion was present in 27.7% of cases, 16.9% once, 7.7% twice and 3.1% three times. In 21.5% of cases, there was a history of curettage and 66.2% had a history of preterm labor. For 4.6% of the subjects, the length of cervix was under 10 mm. Gestational age at the end of cerclage was under 26 weeks in 5.8% of patients. The termination of pregnancy was higher in patients with lower gravida, and the termination of pregnancy was significantly higher in those who were not curetted (P= 0.001). There were no complications, and the prognosis is considered good, in case the termination is above 32 weeks. The birth weight mean was 3041.5 grams. According to our study, the failure of the cerclage is associated with previous history of dilation and curettage (D&C) and higher gravidity.
Conclusion: Putting all the results together, 80% of the cerclage, performed in our institution were successful, without any complications.

Background: One of the most significant factors in the success of dental implant procedures, can be mentioned by the quality and quantity of jaw bone. The occurrence of some problems such as trauma, infection, pathological lesions and the long-term absence of teeth in patients, it causes irregularities in the jaw bone and can get bone resorption. Sever defects after trauma or tumor resection needs bone reconstruction. Sticky bone is a new biological agent that provides stabilization of bone graft in the defect, and therefore, ameliorates tissue repairing and decreases bone loss during healing period. In this study, the evaluation of sticky bone performance to reconstruction of defects in two patients jaw's bone was considered.
Case Presentation: Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.
Conclusion: The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.