A case report of Asyptomatic rupture of a rudimentary uterine horn in a patient with nephrotic syndrome

حاملگی در شاخ فرعی رحم که ارتباطی با حفره اصلی آندومتر ندارد، معمولاً منجر به پارگی شاخ فرعی رحم می شود. پارگی رحم معمولاً ‌با خونریزی شدید پریتوئن همراه است و معمولاً مداخله جراحی اورژانس لازم می گردد. بیماری که معرفی می گردد، گزارشی از یک مورد غیر معمول حاملگی همراه با سندرم نفروتیک شدید و ناهنجاری در رحم می باشد که دچار پارگی در شاخ فرعی گشته و سن حاملگی در زمان پارگی بالاتر از مواردی بوده است که تا بحال گزارش شده است

Diseases Treated With Hyperbaric Oxygen Therapy; a Literature Review

Hyperbaric oxygen therapy (HBO) is defined as the inhalation of 100% oxygen inside a hyperbaric chamber that is pressurized to greater than 1 atmosphere (Atm). Typical HBO regimens use 1.5 to 2.5 Atm pressure for durations of 30 to 90 minutes, repeated multiple times. The time between and the total number of repeat sessions varies widely. The effectiveness of hyperbaric oxygen therapy for treatment of some diseases such as intravascular emboli, decompression sickness, anaerobic infections, CO poisoning was confirmed. For some diseases, such as traumatic brain injuries, the effectiveness of hyperbaric oxygen therapy as described by investigators is controversial. Chinese authors have reported many articles regarding treatment of neonatal hypoxia with hyperbaric oxygen therapy, but in other points of the world, this depth of experience does not exist. Recently, some other diseases, such as purpura fulminans, and pancreatitis, have been treated by hyperbaric oxygen therapy. In conclusion, if equipment for hyperbaric oxygen therapy is available, many patients will benefit by this method of treatment

Prevention of Hypotension During Spinal Anesthesia for Caesarean Section: Preload with Crystalloids or Hydroxyethyl Starch

Prevention of hypotension during spinal anesthesia for cesarean section avoids maternal and fetal side effects. The aim of this study is to compare the effects of prehydration with crystalloid and prehydration with Hydroxyethyl starch on maternal blood pressure and neonatal outcome during cesarean section under spinal anesthesia. We enrolled 72 full term women weighting between 50 and 85 Kg, classified as ASA I, scheduled for elective caesarean section under spinal anesthesia. Participants were randomly allocated equally to one of crystalloid or Hydroxyethyl starch (Voluven) groups. After arrival in the operating room and intravenous (IV) access, 500 ml of ringer solution was infused within 10-15 min before the initiation of the spinal block in the crystalloid group, but in the Voluven group, 500 ml of 6% Hydroxyethyl starch solution was infused to the patients. Hypotension occurred in 47.2% of patients in crystalloid group and 25% of patients in Voluven  group and the statistical difference between two groups was meaningful.(P = 0.008). The incidence of nausea was %41.6 (15 patients) in crystalloid group vs %22.2 (8 patients) in Voluven group. Apgar scores in newborns in both groups were above 8. As conclusion, prophylactic prehydration with Hydroxyethyl starch was more effective than prehydration with crystalloid in the prevention of hypotension during spinal anesthesia for elective caesarean section

Adverse Effects of Diclofenac after Cesarean Section: A Case Report

A 27-year-old nullipara, 38 weeks pregnant, was admitted for elective cesarean section under spinal anesthesia. Past medical history was unremarkable. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine. Ephedrine 10 mg was added to Ringer solution for prevention of hypotension. Hemodynamic parameters were normal and stable during surgery. Several hours later, the patient asked for analgesic drug and two 100mg diclofenac suppositories were administered. Three hours later, the patient suffered from an extensive and cramping abdominal pain. The pain was located in the right upper quadrant and radiated to the right infrascapular region. Electrocardiogram obtained was normal. Intravenous pantoprazole and oral anti-acid were administered, but no decease in pain was seen after fifteen minutes. Subsequently, a sublingual nitoglycerine perle was administered and the intensity of pain was decreased significantly. The diagnosis of Oddi spasm was assumed

Comparison of Oral Mefenamic Acid with Transdermal Glyceryl Trinitrate in the Management of Primary Dysmenorrhea

Background & objectives: Treatment of dysmenorrhea in women is aimed to bring them to their normal condition. In the present study, the effect of mefenamic acid, a non-steroidal anti-inflammatory drug, was compared with that of transdermal glyceryl trinitrate (GTN)&nbsp;as a tocolytic drug in the management of primary dysmenorrhea. Methods: A total of 160 nulliparous women aged 18-30 years with primary dysmenorrhea were included in this single blind, clinical trial, which was carried out from 2014 to 2015. The patients were randomly divided into two equal groups. At the beginning of menstruation cycle, the patients in group A received 500 mg oral mefenamic acid, followed by 250 mg mefenamic acid every 6 hours. The patients in group B initially were administered 2.5 mg transdermal glyceryl trinitrate 0.2% every 12 hours to the abdominal skin under the umbilical cord. Treatment was continued for up to 48 hours and repeated for three cycles. Pain scores were assessed by Numerical Rating Scale (NRS) every 4 hours. Adverse effects such as headache and gastrointestinal disorders were recorded. The decrease of pain scale was the primary outcome and adverse effects were the secondary outcome. Results: The mean pain severity score in in the first 24-hours in mefenamic acid group was lower than that of the glyceryl trinitrate group (p=0.01). On the second day, the mean pain severity scores were not significantly different between the two groups. The mean pain severity scores in the second day of second cycle (p<0.001) and in the first day of third cycle (p=0.001) were significantly lower in mefenamic acid group than in glyceryl trinitrate group. The side effects were also higher in the glyceryl trisitrate group than in the mefenamic acid group, but this difference was not statistically significant. The most common complication was headache in the group receiving glyceryl trinitrate (18.75%) and nausea in the group receiving mefenamic acid (26.25%). The satisfaction rate was 42.2% in the patients receiving transdermal glyceryl trinitrate, while it was 78.5% in patients receiving mefenamic acid; therefore, the patients in the mefenamic acid group were more satisfied (p=0.004). Conclusion: The analgesic effects of oral mefenamic acid were better than transdermal glyceryl trinitrate in the management of primary dysmenorrhea. The adverse effects of these two drugs were not significantly different, but the type of complications was different in both groups

The Comparison of Maternal and Neonatal Outcomes of Normal Vaginal Delivery versus Unplanned Cesarean Section Delivery

Background & objective: &nbsp;&nbsp;One of the objectives of health reform plan in Iran is to reduce the rate of cesarean section delivery. This needs research and use of results to improve the maternal and neonatal outcomes. The aim of this study was to compare the maternal and neonatal outcomes after normal vaginal and cesarean section delivery in hospitalized low-risk mothers in Arash Hospital in Tehran, Iran. Methods: In this prospective cohort study, 1900 low-risk pregnant women, with 37-40 weeks of gestational age, referring to the emergency department and being hospitalized for delivery were included. The data were collected from two groups of patients (normal vaginal delivery and cesarean section delivery). Data on wound infection, abnormal postpartum hemorrhage, decrease of hemoglobin, transfusion requirement, injuries to the genitourinary system, fever until 10 days after delivery, neonatal respiratory complications, NICU admission, jaundice and obstetric injuries were collected by a questionnaire. Results: From 1900 pregnant women, 62.1% had cesarean delivery and 37.9% had normal vaginal delivery. The reasons for cesarean delivery included repeated cesarean (68%), failure to progress (18.1%), and fetal distress (13/9%). Wound infection (p=0. 004), abnormal postpartum hemorrhage (p=0.042) and low hemoglobin (p<0.001) were more frequent in cesarean delivery group than in normal vaginal delivery group. But obstetric injuries were higher in normal vaginal delivery group (p<0. 0001). There was no difference between the two groups in terms of fever ten days after delivery and blood transfusion requirement. For neonatal outcomes, transient neonatal tachypnea (p=0.032), neonatal respiratory distress syndrome (p=0.002), and NICU admission (p<0. 0001) were more frequent in cesarean delivery group than in normal vaginal delivery group. There was no difference between the two groups in neonatal jaundice rate and neonatal injuries. Conclusion: Due to the high rate of cesarean section delivery in our country and higher rate of maternal and neonatal complications after cesarean section delivery, appropriate strategies are required to be applied to decrease unnecessary cesarean section delivery and increase normal delivery with minimum maternal and neonatal complications

Comparison of post-operative nausea, vomiting and laryngospasm in children using control ventilation and spontaneous respiration anesthetic methods

Background and Objective: Post-operative nausea vomiting (PONV) and laryngospasm are the most common of complication following surgery. This study was conducted to compare the incidence of laryngospasm and PONV after pediatric infra umbilical surgery using two anesthetic methods: control ventilation and spontaneous respiration. Materials and Methods: This double-blind clinical trial study was conducted on 192 children with 2-7 year-old undergoing infra-umbilical surgery of ASA-I class with the estimated operation period of an hour in Tehran pediatric hospital, Tehran-Iran during 2009-10. The patients were randomly divided into two groups: controlled ventilation and spontaneous respiration. After anesthetization, Atracurium was injected to the control ventilation (CV) group and anesthesia continued with mechanical ventilation. For the patients of the second group (spontaneous respiration/SR), after the gradual increase of the dose of halothane and certainty of the optimal depth of anesthesia, patients were intubated to allow spontaneous respiration. After intubation, all patients were anesthetized with Halothane 1-2% and the N2O/O2. The rate of nausea, vomiting, laryngospasm, excessive post-operative discharge was recorded. Data were analyzed using SPSS-13, student’s t-test, chi-square and Fisher’s exact tests. Results: Post-operative nausea was non significantly higher in CV group (8%) than SR (6.52%). The rate of vomiting was higher in CV (16%) as compared to SR group (2.17%). (P<0.001, RR=8.57, CI: 1.91-38.41). The rate of laryngospasm at the end of the surgery was higher in CV group (15.21%) as compared to SR group (26%) (P<0.02, RR= 0.94, CI: 0.05-1.77). The rate of excessive discharge at the end of the surgery was significantly higher in CV group (52%) in comparison with SR group (11.95%) (P<0.001, RR=0.94, CI: 0.05-1.77). Conclusion: This study showed that in infra-umbilical surgeries in a period of less than an hour the incidence of post-operative vomiting and laryngospasm is higher in control ventilation group than spontaneous respiration group, which might be due to the injection of neostigmine to counter-act the effects of muscle relaxants

Comparison of successful intubation with two different blades of laryngoscope: single-use and reusable.

BACKGROUND: Many types of single-use blades are manufactured with different designs and materials. There have been several reports of difficulties in obtaining a view of the glottis with single-use laryngoscopes. The purpose of this prospective study was to compare the quickness and the success rate of endotracheal intubations with two different laryngoscope blades: disposable laryngoscope blades and reusable laryngoscope blades. METHODS: The study included 200 patients aged 18 to 70 who were admitted to the operating room of the Ali Ebne Abitaleb Hospital in Zahedan. The patients were randomly divided in two groups. Disposable laryngoscope blades were used for the first group and reusable laryngoscope blades were used for the second group. The endotracheal intubation duration and the failure rate of the intubation were assessed in the two groups. RESULTS: No failures and prolongations of intubations were found in the reusable laryngoscope blades group compared with 21% incidence of prolonged intubations and 14% incidence of failed intubations in the prolonged intubations group which led to change of the laryngoscope by the anesthetists (P&amp;lt;0.05). CONCLUSIONS: The single-use laryngoscope blades appear to be efficient devices because they do not modify the ease of endotracheal intubation in most cases. Nonetheless, for difficult intubations it is advised to maintain conventional laryngoscopes in reserve

The accuracy of placental alpha-microglobuline-1 test in diagnosis of premature rupture of the membranes

Background: Premature rupture of membranes (PROM) is a common obstetric issue during pregnancy which might lead to serious fetal or maternal problems. Therefore, an appropriate diagnosis and management of PROM are of significant importance in patients. Objective: The aim of this study was to determine the accuracy of placental alpha microglobuline-1 (PAMG-1) test in PROM diagnosis and compare this diagnostic method with other standard tests in diagnosis of PROM. Materials and Methods: In this prospective diagnostic accuracy study, patients with symptoms of membrane rupture in 16-39 weeks of gestation were involved. Three tests including Fern, Nitrazine and PAMG-1 were performed at the same time. Results: PROM was confirmed in 86 patients out of 100. The sensitivity and specificity were respectively 81.3% and 100% for Fern test, 93% and 92.8% for Nitrazine test, 98.9% and 92.8% for PAMG-1 test. PAMG-1 test showed higher sensitivity (98.9% with p<0.001) and accuracy (98%) compared with conventional tests. Although PAMG-1showed a lower positive predictive value (PPV) compared to conventional tests such as Fern test (100%), it was shown to be more accurate. Conclusion: The accuracy of PAMG-1 test was superior to both Fern and Nitrazine test in PROM diagnosis