Effect of One versus Two Drain Insertion on Postoperative Seroma Formation after Modified Radical Mastectomy

Background: Modified radical mastectomy (MRM) is still one of globally accepted surgical techniques for breast cancer and in some selected patient is the gold standard type of surgery. The most frequent complication of this procedure is seroma under skin flaps or in the axilla as reported as much as 30% in some studies. The use of closed suction drainage system to reduce the incidence of this complication has been routinely accepted by surgeons; however, length of catheter stay and the number of catheters inserted in the wound are still controversial. The present study compares the results of single versus double drain insertion in patients undergoing MRM for breast cancer.Materials and Methods: The study was conducted on 100 women with breast cancer who were candidate for MRM surgery during 2007-2010 referred to Modarres hospital, Tehran, Iran as a randomized group matched controlled trial.Results: There was no significant difference between the two groups in terms of age, BMI, and tumor weight (P=0.406) (Table 1). Similarly, the difference between the two groups was insignificant in tumor size (T) and number of lymph nodes involved (P=0.145). There was no significant difference between the two groups in timing of axillary drain removal (P=0.064). No significant differences were observed between the two groups in mean aspirated fluid (P=0.071) and mean aspirated sera (P=0.484) after removal of drains.Conclusion: This study revealed one drain insertion in MRM surgery is as effective as two drain and probably less morbidity and cost

Analgesic Effects of Naproxen Suppository and Local Marcaine Injection on Inguinal Hernia Surgery

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are routinely used after surgery, especially after minor procedures such as inguinal herniorrhaphy. Local anesthetics such as marcaine are also used in many minor procedures.Objectives: The aim of this study was to examine the efficacy and safety of a commonly used NSAID, naproxen, versus wound infiltration by marcaine, on inguinal herniorrhaphy. We hypothesized that naproxen would reduce postoperative pain fallowing inguinal hernia repair surgery more effectively than local marcaine injection, but the possible complications may be the same or less.Patients and Methods: In this double-blind controlled clinical trial, 150 patients undergoing inguinal herniorrhaphy were divided into three groups: A (marcaine infiltration in the wound + sup-placebo), B (two sup-naproxen suppositories) and C (sup-placebo). Standard analgesic and antiemetic were available to all the patients. Primary endpoints were postoperative pain, measured at the beginning of the operation, 22 O'clock at night, and the tomorrow morning, using visual analogue scale (VAS) score and the dosage of morphine that the patients needed.Results: Baseline characteristics were equivalent between the three groups. In group B with naproxen, after the operation, decreased pain by 65 ± 23% at the beginning, decreased pain by 34 ± 16% at the 22 O'clock at night and decreased pain by 19 ± 12% at the tomorrow morning were observed. In this group, the patients received 4.4 ± 2 mg less morphine (A), versus the marcaine (B) and the placebo groups (P < 0.001). No side effects or complications were observed fallowing naproxen administration.Conclusions: Naproxen is an effective and low-cost adjunct for pain control after inguinal herniorrhaphy surgery. It is also better than wound infiltration with marcaine because of lower incidence of complications and morphine consumption

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Background: Currently, there is no standard for the use of systemic heparin during creation of Arteriovenous (AV) fistula to decrease the incidence of postoperative thrombotic complications. Objectives: The goal of this study was to evaluate the effects of intra-operative IV heparin on patency rate and postoperative bleeding complications in patients undergoing surgery for AV fistula. Patients and Methods: A prospective, randomized controlled study was performed on 50 patients undergoing AV fistula creation, who were randomly divided in two groups. The control group received no systemic heparin and the heparin group received 5,000 units of intravenous heparin before clamping of theartery. Results: There was a significant difference in patency rate between the heparin and control groups (96% vs. 72%, P = 0.021), and there were no significant differences in operative time (P = 0.55). Perioperative bleeding was not significantly different between the two groups. Conclusions: The results suggest that intra operative administration of heparin has statistically significant effects on patency rates yet not on postoperative bleeding complications. Larger trials with longer follow-up durations and assessment of maturation rates are needed to determine this effect on fistula outcome

Internal Jugular Catheter Malposition in a Patient With End Stage Renal Disease: a Case Report

A 30-year-old female with end-stage renal disease was a candidate for dual lumen catheter placement. After catheter insertion, O2 saturation measurement of the aspirated blood from the catheter was similar to that of arterial blood. They referred the patient to our hospital after 48 hours. Diagnostic procedures revealed that the tip of the catheter had entered the pleural cavity. Catheter removal in the CPR room resulted in hemorrhagic shock. The patient was resuscitated and stabilized and sent to the operating room. A laceration found at the junction of right jugular and right subclavian veins and was surgically repaired. The patient was discharged after ten days without any complication

Gene expression profiling revealed overexpression of vesicle amine transport protein-1 (<i>VAT-1</i>) as a potential oncogene in gastric cancer

161-165Gastric cancer (GC) is one of the most common types of cancer worldwide. Owing to the distinct molecular pathology and the increasing progression rate of GC in Asia, suppression subtractive hybridization (SSH) was used as a high-throughput gene expression analysis method to find genes associated with GC pathogenesis. Total RNA was extracted from the clinical samples, and mRNA was isolated and used in SSH method. The subtracted library was subjected to cloning and the randomly selected clones were sequenced. qRT-PCR was used for expression analysis. The overexpression of vesicle amine transport protein-1 (VAT-1) gene was observed and its expression was analyzed by qRT-PCR in clinical tissue samples. According to the potential oncogenic activity of VAT-1 and its probable surface-occurrence in GC cells, it might be involved in GC pathogenesis and invasion, and it is suggested to be investigated in the diagnosis and therapeutics of GC