Blunt Traumatic Hernia of Diaphragm With Late Presentation

Background: Diaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition. Objectives: We aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm. Patients and Methods: In this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed. Results: Six patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%). Conclusions: Late presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ

Comparing the effects of peritoneal and subcutaneous injections of Bupivacaine on post-appendectomy pain

Background: This study aimed to compare the effects of peritoneal and subcutaneous injections of bupivacaine 0.5% on post-appendectomy pain and also the efficacy of local anaesthetic injection for postoperative pain relief in peritoneal inflammation with subcutaneous injection. Materials and Methods: This randomized-clinical trial was conducted on 126 participants (age range, 15-45 years) underwent appendectomy for acute appendicitis in Kashan Shahid- Beheshti hospital. Participants were divided into three groups: bupivacaine (0.5%, ip), bupivacaine (0.5% s.c), and control (no injection). Pain intensity was evaluated using the visual analogue scale at 6, 12 and 24 hours after surgery. Results: There was no significant difference among the three groups in age, sex, the duration of anesthesia and surgery. Pain intensity (6 h post-surgery) was significantly higher in the subcutaneous group than the peritoneal group, but no significant difference was seen between the two groups at 12 and 24 h post-surgery. Moreover, pain intensity in the peritoneal and subcutaneous groups was significantly lower than the control group at 6 and 12 h post-surgery (P<0.05). There was a significant difference between the peritoneal and subcutaneous groups as well as between the peritoneal and control groups required analgesics, but the difference was not significant between the subcutaneous and control groups. Conclusion: Although both peritoneal and subcutaneous injections of bupivacaine can reduce postoperative pain in patients undergoing appendectomy, the peritoneal injection can significantly reduce the postoperative analgesic consumption

Evaluating the results of bile culture and antibiogram in cholecystectomized patients hospitalized in Kashan Shahid-Beheshti hospital during 2010-2012

Background: Acute and chronic cholecystitis and cholangitis are common cases in general surgical diseases. Considering the role of infections in pathogenesis of these diseases, prescribing appropriate antibiotics is important to control the biliary tract infections. The aim of this study was to recognize the biliary pathogens as well as evaluate their antibiotic susceptibility in cholecystectomized patients. Materials and Methods: This cross-sectional study was performed on 288 cholecystectomized patients with acute and chronic cholecystitis and cholangitis. During the operation, a sterile bile sample was aspirated from the gallbladder which was sent to the laboratory for culture and antibiogram evaluation. Results: Sixty-two (21.5) patients were positive for bile culture. There were more positive cultures in cholangitis cases (64.7) than the acute and chronic cholecystitis (22.8, 12.2, respectively P=0.001). Thirty-six isolated pathogens were E.coli (58) and 8 Klebsiella (12.9). Moreover, the most effective antibiotics against the gram-negative bacteria: imipenem (100), amikacin (98.1) and gentamicin (90.4) and for gram-positive bacteria: imipenem, vancomycin, rifampcin and clindamycin.Conclusion: The third-generation cephalosporins, as an empirical treatment for biliary tract infections, lack the effective antibiotic susceptibility. Considering the high susceptibility (more than 90) and the reasonable price of amikacin and gentamicin, cephalosporins are recommended as the first line treatment for biliary tract infection. Imipenem, an expensive broad-spectrum antibiotic, is not recommended as the first line treatment to avoid drug resistance

The preventive effect of Ampicillin washing on ulcerative infection in perforated and gangrenous Appendicitis

History and Objectives: Considering the incidence of ulcer infection within incision area and its complications and a similar condition in perforated and gangrenous appendicitis and the efficacy of local application of antibiotics in reduction of infection, this study was carried out to evaluate the effect of ampicillin washing in incision area. Materials and Methods: The clinical trial strategy of this study was performed on two groups for patients incised with McBorni method. All of the patients received intravenous injection of metronidazole and gentamicin one day before operation and for 7 consecutive days therefore received ciprofloxacin and were followed up for a period of 1 month. For healing, control group was washed with normal saline and experimental group washed with saline solution and ampicillin. Results: A total of 74 patients in two groups (n=37) were studied and they were alike regarding age and gender. The incidence rate in control and experimental group was 13.5 and 10.8 respectively that was non-significant statistically. In addition, age, gender and type of complication played no role in infection. Meanwhile, a thickness greater than 2cm for subcutaneous tissue can increase the incidence rate. Conclusion: It is concluded that ampicillin washing in comparison to saline itself can not affect the incidence of infection. It is recommended to perform more studies on ulcers with a subcutaneous thickness greater than 2cm

Efficacy of drainage following an uncomplicated laparoscopic cholecystectomy

Background: Although laparoscopic cholecystectomy is the preferred method for cholecystectomy, performing routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, the present study aimed to evaluate the effect of using a drain on complications following an uncomplicated laparoscopic cholecystectomy. Materials and Methods: In this study, 86 patients with biliary colic were candidates for laparoscopic cholecystectomy. The patients were randomly divided into two (the intervention and control) groups. In the intervention group, a drain was placed postoperatively, but the control group did not receive any intervention. The amount of fluid collection, length of hospital stay, recovery rate and the visual analog scale (VAS) for pain were recorded in all patients.Results: Mean age of patients was 46.33±12.53 and 45.88±10.66 years in the drain and non-drain groups. The drain group was hospitalized 0.76 days more than the non-drain group (P=0.001). Complications were seen in the drain (7) and non-drain (4.7) groups. VAS was significantly higher in the drain group than the non-drain group (P=0.001).Conclusion: Drainage does not have a positive effect on the postoperative abdominal secretions, recovery and the probable complications. Moreover, it can cause a significant increase in both length of hospital stay and pain score

Epidemiology of Chest Trauma in Kashan Trauma Centers

Background: Trauma is the most common cause of death between the ages of 1 and 44. Chest trauma as a potentially life threatening injury is increasing with increased number of high-speed accidents in Iran. Materials and Methods: 282 patients were treated for chest trauma in our center between March 2003 and September 2007. Data including the patients' age and gender, blood pressure, respiratory rate on admission, Glasgow Coma Scale (GCS) scores, Revised Trauma Score, types of trauma, the extent of intra thoracic injury, types of associated injuries, length of hospital and ICU stay, morbid conditions, and deaths were recorded and analyzed. Results: 237 patients were male (84%), and 45 female (16%). Mean age was 37.67±19.14 with the age range of 6 months to 84 years. 222 patients (78.7%) had blunt and 60 (21.3%) penetrating chest trauma. Motorcycles and car accidents were the most common etiologic causes in 167 (59.3%). Rib fracture was the most common thoracic injury with 178 (63%) and pelvic and limb injuries the most frequent extra-thoracic injury with 93 (33%). Seventy percent of patients were treated with either closed thoracostomy drainage or clinical observation while 71 (25%) needed surgical intervention during the first 24 hours. The most common operation was laparotomy. Mean duration of hospital stay was 7± 9.6 (range: 1-70) and ICU stay 1.9days. Out of 282 patients overall mortality was 33 (11.7%) and pulmonary infection 12 (4.2%). Conclusion: Chest trauma is a major preventable cause of mortality and morbidity in our country. Systolic blood pressure ≤90, pulse rate ≥120, respiratory rate >29, GCS <8 at the time of admission, and blunt type of trauma were found as the predictors of mortality and morbidity

A clinical survey,diagnostic method,treatment and follow- up of hydatid disease in referred patients to Shahid Beheshti Hospital during (1996-2005).

History and Objective: Human hydati d disease has been world widely spread and its frequency ,clinical presentation, diagnostic methods, treatment and recurrence rate were reported variously. For determining the frequency, surgical results, and recurrence rate, this study was performed in Kashan area. Material and Methods: A cross-sectional study on patients with hydatid disease was caried out. Age,sex,living side, clinical loboratory , imaging finding, anatomic location. and operation procedure, were all considered.At the end of the investigation for recurrency, chest X-rey pA Ultra sonography of abdomen and indirect hemagglotination test IHT was performed. Finding: From 135cases (62.2) were female,FM/M:1.6/1 the incidence pick was in (2-30). 58. living in rural area 68 of cyst was in abdomen (liver) and 30 pulmonary, caught and then sputum was the most frequent symptom in pulmonary hydatid disease, abdominal pain and fever in liver hydatid disease was more frequent.  Casoni test in 85.3 pre-operation was positive and indirect hemagglotination test IHT serology after 5years 90 was positive Diagnosis of liver cyst was confirmed by ultra sonography in 98 in lung with chest X ray and CT scan 88.9 and 100 respectively.The most common procedure in liver was cystectomy and omentoplasy ,in lung was systectomy.  We did not use any scolocidall agent and had 4 patients recurrence in liver 3 but no any patient had pulmonary Recurrent. indirect hemagglotination test IHT after 5 years operation in 88.4 was positive Conclusion: It seams that after perfect surgery no scolocidal drug administration is necessary and indirect hemagglotination test IHT is an excellent sero diagnostic mean