Recommending Different Treatments as Preventive Measures against Incisional Endometrioma

Abstract Objective: To consider incisional endometrioma (IE) as a differential diagnosis of abdominal disorders and to recommend different treatments as preventive measures. Incisional endometrioma (IE), as a rare condition, usually develops in surgical scar of cesarean section or hysterectomy. Materials and methods: We performed a retrospective review of 12 cases at Department of Surgery, Shahrekord University of medical sciences, Shahrekord from August 2010 to August 2012. The participants were diagnosed with IE using their pathology specimens. Results: The age ranges were from 23 to 44 years (mean age 32.75 years). A total of 12 patients had previous cesarean sections through a Pfannenstiel incision, which the wound was managed with regular irrigation, but peritoneum was not repaired. The main symptom was an abdominal wall mass about the previous caesarean section surgical scars, associated with cyclic pain. The mean duration of symptoms was 6 to 24 months (mean duration 6.66 months). There was 100% recovery after surgical treatment without any relapse of symptoms during follow-up till now. Conclusion: We recommend irrigation of the wound with high-jet saline solution before wound closure and repair of peritoneum at the time of cesarean section as a preventive measur

Isolated hydatid cyst of the breast that developed after breast feeding

A hydatid cyst of the breast is extremely rare, even in endemic areas. There are few reports of breast hydatid cysts. We report a case of an isolated hydatid cyst of the breast that was identified as a painless breast lump that had increased in size just after completion of breast feeding and was present with a painful breast mass after 25 years. This may indicate the possibility of retrograde passage of an Echinococcus granulosus egg through lactating ducts during breast feeding, liberation of an embryo that penetrates ductal mucus and enters the breast tissue and then develops into a hydatid cyst. When a patient comes from an area with little healthcare and where hydatid cysts are epidemic, and if this disease was indicated by radiologic or serologic examination, total mass excision without spillage is the best diagnostic and treatment

A comparative study on lecture based versus case based education on teaching general surgery to medical students

ntroduction: various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001). In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7%) in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged

The effects of preoperative milk drinking on gallbladder perforation during laparoscopic cholecystectomy

Abstract: One of the complications of laparoscopic cholecystectomy (LC) is gallbladder perforation during surgery. Fasting before surgery causes gallbladder distention, which may increase the chance of iatrogenic gallbladder perforation during LC. A fatty meal stimulates endogenous cholecystokinin release and, consequently, the gallbladder contraction. This study evaluates the effects of preoperative milk drinking on gallbladder distention and iatrogenic gallbladder perforation during LC. This study was performed on patients who were candidates for elective LC in a university hospital from March 2011 to March 2012. Patients were randomly divided into two equal groups. The case group drank 300 mL of cold full-fat pasteurized cow’s milk, while the control group drank 300 mL of cold water as the placebo, six hours before LC surgery. Data were collected in a questionnaire and analyzed using descriptive statistical tests, t-test, and ANOVA analysis. In the 260 patients, despite a lack of significant differences in demographic and risk factors for gallbladder perforation between the two groups, both distention and gallbladder perforation rates were significantly lower in the case group than in the control group (P = 0.001 and, P = 0.032, respectively). Thus, drinking cold full-fat pasteurized cow’s milk before LC surgery can reduce gallbladder distention and, consequently, the risk of gallbladder perforation during L

Leiomyosarcoma of the inferior vena cava

Inferior vena cava leiomyosarcoma is a rare tumor with a variety of symptoms. A 41-year-old woman was admitted with nonspecific epigastric pain. Computed tomography revealed a dense mass between the inferior vena cava and the liver. The patient underwent successful resection of the mass. The pathologic study confirmed leiomyosarcoma. Adjuvant radiation therapy was completed, and after 12 months of follow-up, the patient had no problems. © 2014 SAGE Publications

Comparison Efficacy of Topical Piroxicam Gel and Lidocaine with Intravenous Pethidine in Reducing Pain during ESWL

Introduction & Objective: ESWL is a non-invasive method of breaking stones, using acoustic shock waves. Shock waves cause temporary deep visceral pain and discomfort in entry; therefore, administration of sedatives is necessary. The purpose of this study was to compare the effect of topical lidocaine and piroxicam gel with intravenous pethidine in reducing pain during ESWL. Materials & Methods: This clinical trial study was performed on 159 patients who referred to Ayatollah Kashani Hospital in Shahrkord for ESWL in 2009. Patients were randomly divided into three-groups. For the first group, intravenous pethidine (0.5 mg/kg alone) was administered. The second group received topical piroxicam, and the third group received topical lidocaine in the area of flank for half an hour before ESWL. During the operation, those patients who had unbearable pain, received another 0.5 mg/kg of pethidine. Data was collected using MC Gill questionnaires and analyzed using the SPSS software, using parametric, nonparametric methods and Dunn's Multiple Comparisons tests. Results: The mean of pain scores in the first group (pethidine) was 6.2 ± 6.9 while these scores were 3.2 ± 2 .7 and 3.9 ± 3.1 for the second (piroxicam gel) and third group (lidocaine gel) respectively. The differences in the mean score of pain was significant in the pethidine group compared to the other groups (P <0.05). The average pethidin consumption were 24 ± 16 mg for the first group (pethidine), 10 ± 13 mg for the second group (piroxicam gel), and 5 ± 9 mg for the third group (lidocaine gel). The mean difference was significant in pethidine treated group in comparison with other two groups (P < 0.05). Conclusion: The use of topical piroxicam or lidocaine reduces pain in patients after ESWL It also reduces the need for sedative drugs

Effect of vasectomy on sexual function in men

زمينه و هدف: مردان ممكن است عملكرد جنسي متفاوتي بعد از وازكتومي داشته باشند. مطالعـه حاضـر بـا هدف بررسي تاثير وازكتومي در عملكرد جنسي مردان انجام شده است. روش بررسي: در اين مطالعه باليني تعداد 100 نفر از مجموع 120 نفري كه از مهر ماه سال 85 لغايـت مهـر ماه سال 87 به طور داوطلبانه جهت عمل وازكتومي به بيمارستان آيت اله كاشاني شـهركرد مراجعـه نمودنـد و مايل به همكاري در اين مطالعه بودند انتخاب شدند . توانايي جنسي افراد تحت مطالعه، قبل و سـه مـاه بعـد از انجام وازكتومي بر اساس پرسشنامه ارزيابي عملكرد جنـسي IIEF ) Function Erectile of Index International( ارزيابي و داده ها با استفاده از آزمون آماري ويل كاكسون مورد بررسي قرار گرفت. يافته ها: ميانگين سني افراد /5 10/ ±5 31 ،ميانگين امتياز كلي IIEF قبل از عمل جراحي 12/58 و پس از عمـل جراحي 59/63 ) بود 001 0 /P (. <در 43 %از بيماران امتياز بالا، 41 %امتيـاز پـايين و 16 % افـراد نيـز تغيـري در امتيازها قبل و بعد از عمل وازكتومي نداشتند . 5 از حيطه عملكرد جنسي در حيطه هاي رضـايت بخـش بـودن عملكرد جنسي، عملكرد نعوظي و رسيدن به اوج لذت جنسي از نظر آماري پس از عمل جراحي بهبودي معني داري وجود داشت (03 0 /P(. = نتيجه گيري: اين مطالعه نشان داد كه انجام وازكتومي علاوه بر اينكه تاثير منفي بر عملكرد جنسي ندارد، بلكه در حيطه هاي رضايت بخش بودن عملكرد جنسي، عملكرد نعوظي و رسيدن به اوج لـذت جنـسي (ارگاسـم) باعث بهبودي مي گردد

Penetrating Neck Trauma: Review of 192 Cases

Background: The neck region contains a high density of vital organ structures within a relatively small and unprotected anatomic region, making it one of the most vulnerable areas of the body for all types of injuries. Objectives: In this article, we studied penetrating neck trauma cases in Alzahra Hospital over a 10-year period. Patients and Methods: In this retrospective, descriptive, analytical study, penetrating neck trauma cases admitted to Alzahra Hospital between April 2000 and April 2010 were analyzed for epidemiology, mechanism of trauma, zone of trauma, therapeutic method, injuries to other organs, complications, and mortality. Results: Among 192 penetrating neck injuries, the mean age at the time of injury was 25.08 ± 15.02 years. Of these cases, 96.4% percent occurred in men. The most common mechanisms of trauma was stab wounds (85.93%). In 56.3% of penetrating neck injuries, zone 2 was involved. Neck exploration was positive in 84.4% of cases, and 52.1% of patients underwent surgery. Vascular exploration was the most common cause of surgery (67.2% of patients). The most common surgical intervention was vein ligation (50.8% of cases). In 11.98% of cases, another organ injury occurred simultaneously, and chest injury was the most common coexisting problem (65.2%). Complications were reported in 9.3% of patients, and the need for intubation was the most common complication (5.2% of patients). Mortality rate was 1.5%. Conclusions: According to the findings of this study, the most common cause of penetrating neck injuries was stab wounds, and the majority of patients were young men, therefore, preventive measures should be implemented. Because of fatal complications associated with neck injuries, we recommend early neck exploration in unstable cases or when injuries are deeper than the platysma

Compare the effectiveness of face-to-face educationwithleaflet on preoperative knowledge of patients undergoing elective surgery- A randomized clinical trial

زمینه و هدف: طبق شواهد موجود بیماران از عدم دریافت اطلاعات لازم جهت آمادگی قبل از عمل و مراقبتهای پس از عمل رنج می برند. این مطالعه به مقایسه تأثیر دو روش آموزش کلامی چهره به چهره و آموزش از طریق پمفلت بر میزان دانش بیماران کاندیدای عمل جراحی غیراورژانس پرداخته است. روش بررسی: در این مطالعه کارآزمایی بالینی، 90 نفر بیمار کاندیدای عمل جراحی غیراورژانس با روش نمونه گیری تدریجی آسان وارد مطالعه گردیدند و به طور تصادفی و تدریجی دریک گروه کنترل و دو گروه آزمون (گروه آموزش کلامی چهره به چهره و گروه آموزش از طریق پمفلت) توزیع شدند. متغیر وابسته پژوهش را سطح دانش بیمار در مورد آمادگی های قبل، حین و پس از جراحی تشکیل می داد که با استفاده از آزمون دانش چند گزینه ای قبل و پس از مداخله مورد سنجش قرار گرفت.. یافته ها: دانش قبل از عمل بیماران پس از انجام مداخله در گروه های آزمون بطور معنی داری بالاتر از گروه شاهد بود (05/0>(P ولی بین دو گروه آزمون تفاوت معنی داری بدست نیامد (05/

Assessment of oral acetazolamide on postoperative pain after laparoscopic cholecystectomy

Background and aim: Carbon dioxide (Co2) is used during laparoscopy for producing pneumoperttoneum. Combination of this gas with irrigation fluid in the abdomen produces carbonic acid which creates two kinds of abdominal and referred pain to right shoulder. In the present research we have studied the effect of oral acetazolamide in reducing postoperative pain after laparoscopic cholecystectomy. Methods: This clinical trial was performed in 88 patients with cholelithiasis without any complication that were candidate for laparoscopic cholecystectomy. The patients devided randomly and equally in two groups. The experimental group received Acetazolamide (250mg orally 24 hours before surgery every 8 hours) and control group received placebo. Abdominal and shoulder pain measured using Mc Gill pain score by a person who was blind for both groups. Pain measurement was performed in four different times before and after the surgery discharge from recovery and 24 hours after surgery. Data were analyzed by using SPSS software. Results: We observed that mean pain scores was significantly higher in acetazolamide group compared to the placebo group 24 hours after the operation (P0.05). Conclusion: Although acetazolamide can reduce abdominal pain referred to right shoulder by reducing acidity in peritoneal irrigation fluid but this drug can increase abdominal pain in the site of surgery with damaged tissues by producing tissue acidosis (as a side effect of drug)