DR. SAKINEH PARI, PRVA IRANSKA KIRURGINJA

Modern surgery has been evolved in Iran by the establishment of Dar al-Funun and Tehran University in 1851 and 1934 respectively. Professor Yahya Adl established the first academic department of surgery at Tehran University in 1930s and he is known as the father of modern surgery in Iran. Until recent times, women’s options for obtaining advanced surgical training programs were severely restricted all over the world. Dr. Sakineh Pari, born in 1902, was the first Iranian female surgeon. The aim of this article is to introduce Dr. Sakineh Pari as the first woman surgeon in Iran.Moderna iranska kirurgija razvija se od osnivanja sveučilišta Dar al-Funun 1851. godine odnosno teheranskog sveučilišta 1934. godine. Professor Yahya Adl, otac iranske moderne kirurgije, osnovao je tridesetih godina 20. stoljeća prvu katedru za kirurgiju na teheranskom sveučilištu. Sve donedavna mogućnost da ženi bude dodijeljen napredni program kirurškog usavršavanja bio je svugdje u svijetu znatno ograničen. Profesor Adl pokrenuo je u Iranu specijalističko usavršavanje u kirurgiji, no slično drugim zemljama, žene su bile manje poželjne i imale su manje izgleda za dobivanje specijalizacije. Dr. Sakineh Pari, rođena 1902. godine, bila je prva iranska kirurginja. Živjela je u nerazvijenim gradovima sjevernog Irana i bila je desetljećima na usluzi siromašnima

Vacterl association with hypertrophic pyloric stenosis

The acronym VACTERL is actually a combination of associated anomalies. We found a case of VACTERL association with hypertrophic pyloric stenosis. A six-weeks-old male infant was referred to us with hypertrophic pyloric stenosis. He had a history of esophageal atresia, imperforated anus and cardiac anomalies. This case shows hypertrophic pyloric stenosis in a patient with ‘VACTERL’ anomalies

Results of gastric pull-up procedure in neonatal long-gap esophageal atresia: a single center prospective study

Introduction: The management of long-gap esophageal atresia (LGEA) remains challenging and esophageal replacement is inevitable in some patients. The current study aimed at assessing the outcomes of gastric pull-up surgery for esophageal reconstruction in neonates with LGEA, and investigating the postoperative results, complications, and mortality.Materials and Methods: In a prospective study 16 patients with LGEA were studied at Tabriz Children’s Hospital, Tabriz, Iran. Gastric pull-up technique was used for esophageal replacement in all the patients. The study duration was 23 months from April 2014 to March 2016.Results: The mean age of the neonates was 7.31 ± 3.91 days. Eleven patients (68.75%) were male and five (31.25%) female. Seven neonates (44%) had esophageal atresia type A and nine patients (56%) had type C. All of them (100%) were in need for postoperative mechanical ventilation. Mean period of postoperative mechanical ventilation was 0.87±5.69 days. Postoperative mortality was observed in three patients (18.75%). Patients were followed up for six months after the operation; poor feeding was observed in four patients (30.77%), mild respiratory distress in three patients (23.08%), and choking and aspiration in three patients (23.08%).Conclusion: It was observed that gastric pull-up technique is a feasible and safe surgical method for neonates with long-gap esophageal atresia when primary anastomosis is not possible. Quality of life, feeding, and growth pattern were also acceptable. However, long-term outcomes were not assessed in the current study

Anal Sphincter: A Comprehensive Review

Anal incontinence is of potential clinical interest and significance. Comprehensive knowledge of anal clinical anatomy and function is essential to understand pathophysiological processes that lead to sphincter malfunction. We review anatomy, physiology and surgical pathology of the anal sphincter. We also discuss surgical procedures which are used in cases of fecal incontinence.

Outcome of children operated for congenital anorectal malformations: A prospective single center study

Introduction: Anorectal malformations (ARM) have an incidence of 1 in 5000 live births and affect male and female almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, longterm outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of our study was to assess the outcomes of children undergoing surgical correction of ARMs.Materials and Methods: In a prospective follow-up study, we wanted to assess occurrence of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at followup visits. In addition, the decision of research team on patients at followup visits was considered as secondary outcomes.Results: Two hundred and ninety patients were studied. Of the study patients, 174 (60.4%) were boys and 114 (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years and mean age of girls was 5.0 ± 2.0 years. The mean follow-up period of our patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.Conclusion: We found that the most common complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. In 3.1% of the study population reoperation was required. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was also acceptable

Is there any correlation between duration of vomiting before pyloromyotomy and eradication of symptoms after pyloromyotomy in hypertrophic pyloric stenosis?

Introduction: Hypertrophic pyloric stenosis (HPS) is among common GI disorders in young infants, with an incidence of 1-2:1000 live births in the world. In this study, we wanted to investigate the correlation between duration of symptoms before surgery and eradication of symptoms after pyloromyotomy in HPS.Materials and methods: One hundred and twenty five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between 2004 and 2014 at pediatric surgery ward of Tabriz Children’s Hospital, Iran. The demographic features, clinical findings, diagnostic work-up and postoperative specifications of the patients were studied retrospectively.Results: We studied 125 patients with HPS. Male to female ratio was 4:1. The patients were 16 to 90 days of old and the mean age was 39±1.42 days. The range of pyloric canal length was 7.60 to 29.00 mm and the mean length was 19.54±3.42 mm. Pyloric muscle diameter was 2.70 to 9.00 mm and the mean diameter was 4.86±1.14 mm. Seventy two percent of patients had episodes of vomiting after operation. Mean time of persistence of vomiting after pyloromyotomy was 15.73±0.15 hours. Mean discharge time was 55.22±0.08 hours. Radiologic findings did not show any significant correlation with persistence of vomiting or discharge time. Conclusion: The present study revealed that duration of vomiting before surgery and continuing symptoms could not predict postoperative symptom eradication after pyloromyotomy in HPS

Fetus-in-Fetus: Our Case Series and Review of the Literature

Fetus in fetu is a rare condition commonly presenting as an epitomized pedunculated vertebrated fetiform mass in a newborn infant. Different kinds of presentation and locations have been reported in the hosts. Although numbers of instances have been reported the fascination and curiosity about other presentations and genesis of fetus in fetu remains confirmed. In Tabriz pediatric surgery ward we have had five different presentations of fetus in fetu. The aim of this case series and a subtle literature review is gathering these interesting presentations

THE EFFECT OF QUINCE LEAF (CYDONIA OBLONGA MILLER) DECOCTION ON TESTES IN HYPERCHOLESTEROLEMIC RABBITS: A PILOT STUDY

Current medical literature lacks any evidence of the protective effects of quince leaf on testes. Therefore, the aim of the present study was to assess the effect of quince (Cydonia oblonga Miller) leaf decoction on testicular injury and impaired spermatogenesis induced by hypercholesterolemia in rabbits. Eleven mature New Zealand white male rabbits were randomly divided into three groups: group 1 (hypercholesterolemia, n=3), group 2 (hypercholesterolemia plus quince treatment, n=6), and group 3 (control, n=2). Groups 1 and 2 received a cholesterol-enriched diet for six weeks. Group 2 received C. oblonga leaf decoction as drinking supplement as well. After six weeks, a normal diet was substituted in groups 1 and 2 for another six weeks. Group 3 (control group) was maintained throughout the study on a regular diet. At the end of the 12th week, the left testes of the animals were resected for light microscopic study with particular attention to the maturity of germ cells in seminiferous tubules using Johnsen’s score. Increase in intertubular connective tissue and diameter of vessels, abundant spermatogonia and primary spermatocytes along the reduced germinal epithelium were noted in all rabbits of the group 1. The remaining animals in groups 2 and 3 had no significant changes in their testicular sections. The mean Johnsen’s score of group 1 (4.20±1.92) was significantly lower than that of group 2 (7.33±0.52) and group 3 (7.05±0.07). (P=0.01). In conclusion, quince leaf decoction (C. oblonga Miller) protected rabbit testes and spermatogenesis from damage induced by hypercholesterolemia