Evaluation of the Housekeeping Genes; β‐Actin, Glyceraldehyde‐3‐Phosphate‐Dehydrogenase, and 18S rRNA for Normalization in Real‐Time Polymerase Chain Reaction Analysis of Gene Expression in Human Adipose Tissue

Background: Several studies suggested that beta-actin, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and 18S rRNA are expressed constitutively and contribute to the fundamental reference actions essential for cell viability and maintenance. However, there are inconsistency in this regard. Hence, we aimed to evaluate the accuracy of these three potential reference genes for Real‐Time quantitative reverse transcriptase‐polymerase chain reaction (qRT‐PCR) application for normalization in two types of human adipose tissues.Materials and Methods: Subcutaneous and visceral fat tissues were derived from 19 healthy and 20 obese subjects and RT-qPCR was applied to determine the expression levels of beta-actin, GAPDH, and18S rRNA.Results: The gene expression level of beta-actin, GAPDH, and 18S rRNA was essentially the same in the subcutaneous and visceral fat tissues of all participants (P>0.05). Hence, all considered housekeeping genes displayed high expression stability and the analysis revealed that normalization to all of these three housekeeping genes gave a result that satisfactorily reflected the acceptable mRNA expression levels in adipose tissues.Conclusion: Collectively, our findings suggest of beta-actin, GAPDH, and18S rRNA as reference genes applicable in human adipose tissue in the context of obesity

Ileal intussusception secondary to both lipoma and angiolipoma: a case report

Lipoma and angiolipoma are common benign neoplasms that occur in the subcutaneous tissue and rarely in the gastrointestinal tract. These tumors are usually asymptomatic but may present with abdominal pain, bleeding and obstruction. We present a 53-years-old woman with abdominal discomfort for several weeks accompanied with bloody diarrhea and recurrent vomiting. Ileo-ileal invagination was diagnosed by computed tomography scan. Laparotomy revealed five intraluminal masses that caused intussusception. Histopathological study showed that one was angiolipoma and other lesions were lipoma. We have described some aspects of diagnosis and treatment of this rare cause of intestinal intussusception

Minimum Number of Required Sessions for Attaining Basic Skills in Laparoscopic Surgery by General Surgery Residents; an Experimental Report

Introduction: Training is the primary route of attaining required skills among residents in general surgery. Objective: This study was conducted to evaluate the minimum number of required sessions for attaining basic skills in laparoscopic surgery in a skill-lab among surgical residents. Method: This cross-sectional study was conducted in Imam-Khomeini Hospital during 2012. A total of 20 surgical residents were enrolled. There were 45–60 mins sessions weekly, which included the following seven elementary skills: first knot tie, second knot tie, peg exchange, peg drop, rope pass, needle pass, and paper cut. These skills were evaluated weekly, and qualitative evaluations were done every 2 weeks. Results: Mean age of the 20 surgical residents was 32.2 ± 4.7 years, and 55.6% of them were males. The median session counts were as follows: six sessions for first knot tie, six sessions for second knot tie, three sessions for peg exchange, eight sessions for needle pass, and five sessions for paper cut. Conclusion: Based on the obtained results, it may be concluded that relatively five sessions are required for acquiring basic skills in laparoscopic surgery by surgical residents

Effect of Low-Dose Naloxone on Pain Severity and Side Effects of Opioids on Patients Undergoing Laparoscopic Cholecystectomy

Background: Previous studies have assessed effect of naloxone on pain severity and side effects of opioids however, their results are inconsistent. Our study was design to determine effect of low-dose naloxone on pain, nausea, vomiting, pruritus and urine retention on patients undergoing laparoscopic cholecystectomy. Materials & Methods: In this study 60 patients who need laparoscopic cholecystectomy participated and divided into two groups: naloxone (0.25 mg/kg/h naloxone plus 20 mg/kg/h morphine) and placebo (20 mg/kg/h morphine). Patients were evaluated 2, 4, 8 and 16 h after surgery and severity of pain and side effects including nausea, vomiting, pruritus and urine retention were recorded by a nurse. Results: Prevalence of nausea, vomiting, pruritus and urine retention in naloxone group was significantly lower than placebo 2, 4, 8 and 16 h after surgery. There was no significant difference on pain severity between two groups. Conclusion: Our results indicated that naloxone administration significantly decreased side effects of opioid including nausea, vomiting, pruritus and urine retention with no effect on pain severity

Penrose Drain Migration After Laparoscopic Surgery

Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD). While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum

Minimal access mediastinal surgery: One or two lung ventilation?

Background : Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. Methods : In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. Results : In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon′s opinion with regard to exposure were similar for both groups. Conclusion : Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT

Mid-term results of thoracoscopic thymectomy for myasthenia gravis

Context : Video-assisted thoracic surgery (VATS) has been proposed as a less invasive technique for treatment of myasthenia gravis. Materials and Methods : A total of 31 patients underwent a right-sided VATS to remove all anterior mediastinal fat and thymic tissue during a 4-year period in our institution. None of the patients had associated thymoma. Results : All procedures were performed successfully with no conversion to sternotomy. The mean operating time was 190 minutes. The median intubation time and assisted ventilation were 24 and 18 hours, respectively. The median ICU and hospital stays were 3 and 7 days, respectively. The median time for post-operative chest drainage was 48 hours. There was no perioperative mortality. Eight significant complications occurred. One patient had atelectasis, 1 patient had aspiration pneumonia, and 3 patients had postoperative myasthenic crisis and required prolonged mechanical ventilation. Other complications were granuloma of the vocal cord, right recurrent laryngeal nerve palsy, and temporary brachial plexus injury due to poor intraoperative positioning. The mean length of follow-up was 20 months (range: 3-42 months). Overall, 27 patients (87%) had improved clinically and 11 patients (35%) had complete remission. The resulting scars were cosmetically acceptable for all patients. Conclusion : VATS provides an effective alternative approach to thymectomy and has several advantages over open techniques. VATS causes minimal postoperative complications, shortens hospital stay, and gives better cosmetic results