ORIGINAL_ARTICLE
Platele Rich Plasma for Traumatic Non-Union Fractures: A Novel but Controversial Bone Regeneration Strategy
https://beat.sums.ac.ir/article_44225_2e2d97e16244740b4fdc4d6c6bd8e39d.pdf
2013-07-01
99
101
Plasma Rich Plasma
Traumatic Non-Union Fractures
Bone Regeneration
Fariborz
Ghaffarpasand
fariborz.ghaffarpasand@gmail.com
1
Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
LEAD_AUTHOR
Maryam
Dehghankhalili
2
Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Mostafa
Shahrezaei
3
Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran.
AUTHOR
ORIGINAL_ARTICLE
The Effect of Routine Maintenance Intravenous Therapy on Hemoglobin Concentration and Hematocrit during Anesthesia in Adults
Objective: To investigate the decrease in hemoglobin concentration and hematocrit during elective surgery.Methods: This was a prospective study being performed in Nemazee Hospital of Shiraz University of Medical Sciences. We included a total of 50 American Society of Anesthesiology (ASA) I and II patients undergoing elective minor surgeries. Perioperative fluid administration was performed for all the patients and hemoglobin and hematocrit levels were measured three times: Once before the operation, once one hour after start of operation and once in the recovery room. Values were compared using paired sample t-test.Results: The mean age of the patients and controls was 39.66 ± 8.27 years. Hemoglobin level decreases significantly after one hour (p<0.001) and after the end of operation (p<0.001). In the same way hematocrit level was decreased significantly after one hour (p<0.001) and after the end of operation (p<0.001).Conclusion: In this patient population undergoing elective minor operations, there was significant decrease in the hemoglobin and hematocrit levels in response to the IV fluids administration.
https://beat.sums.ac.ir/article_44217_2cd25b02978a013e70d0388e56f402c6.pdf
2013-07-01
102
107
Hemodilution
Hemoglobin
Hematocrit
Perioperative fluid administration
Seyed Masoud
Lahsaee
1
Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Sina
Ghaffaripour
2
Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Hossein
Hejr
3
Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Characteristics and Surgical Approach in Post-Traumatic Diaphragmatic Hernia: A Single Center Experience
Objectives: The aim of this study was to evaluate the surgical approach in post traumatic diaphragmatic hernia.Methods: This prospective cross-sectional study was conducted in the Department of cardiovascular and thoracic surgery, Sher-i- Kashmir Institute of Medical Sciences (SKIMS), Kashmir, India. We included all patients with post traumatic diaphragmatic hernia undergoing operation in our center from May 2009 to November 2011. A detailed history was taken for each patient along with comprehensive general, physical, systemic and local examination of all cases. Operative findings included associated intra-abdominal injuries, and herniated intra-abdominal organs. Post-operative complications, mortality and survival were recorded and reported.Results: The mean age of the patients was 32±1 years and there were 16 (76.1%) men and 5 (23.8%) women among the patients. Thoracotomy was performed in 14 patients (66.7%), laparotomy in 6 patients (28.6%) and combined procedure was used in 1 patient (4.7%). The reduction of hernia contents with repair of diaphragmatic rent was done in 11 (52.2%) of the patients and splenectomy with repair of rent in 6 (28.6%). Traumatic diaphragmatic hernia had 81.8% survival rate, no pre-operative mortality and 14.3% post operative mortality rate.Conclusion: Thoracotomy is the most common approach in post traumatic diaphragmatic hernia. Laparotomy is preferred in patients having acute trauma with associated intra-abdominal injuries.
https://beat.sums.ac.ir/article_44218_0b4133ba14b6a2a0b25efbbc6e3ce2d9.pdf
2013-07-01
108
111
Post traumatic diaphragmatic hernia
Surgical approach
Thoracotomy
Farooq
Ahmad Ganie
1
Department of Cardiovascular and Thoracic Surgery, Soura, Srinagar, Kashmir, 190011, India.
LEAD_AUTHOR
Ghulam Nabi
Lone
2
Department of Cardiovascular and Thoracic Surgery, Soura, Srinagar, Kashmir, 190011, India.
AUTHOR
Mushtaq Ahmed
Chowdhary
3
Department of Cardiovascular and Thoracic Surgery, Soura, Srinagar, Kashmir, 190011, India.
AUTHOR
Hafzulla
lone
4
Department of Cardiovascular and Thoracic Surgery, Soura, Srinagar, Kashmir, 190011, India.
AUTHOR
ORIGINAL_ARTICLE
Short-term Outcome of Early Tracheostomy in the Trauma Patients Admitted to Intensive Care Unit: A Comparative Study
Objectives: To compare the results of early versus late tracheostomy in trauma patients admitted to intensive care unit (ICU).Methods: This was case control study being performed at a major trauma centre in Shiraz, Iran including 120 trauma patients admitted to ICU during a 2-year period and underwent tracheostomy during their ICU stay. The patients were categorized into two groups of the early tracheostomy who underwent tracheostomy within the first 7 days of initiation of mechanical ventilation (n=60), and the late tracheostomy group, in which tracheostomy was performed after 7 days (n=60). The duration of mechanical ventilation, ICU stay and hospital stay as well as mortality rates in ICU and hospital were recorded and compared between two study groups.Results: The baseline characteristics such as age (p=0.325), sex (p=0.071), Glasgow coma scale (GCS) (p=0.431) and the mechanism of injury (p=0.822) were comparable between two study groups. Early tracheostomy was associated with a significantly shorter duration of mechanical ventilation (p=0.008) and shorter ICU stay (p=0.003). Hospital stay (p=0.165), ICU mortality (p=0.243), and hospital mortality (p=0.311) were not different between the two study groups.Conclusion: Early tracheostomy is associated with reduced ICU stay and shorter duration of mechanical ventilation. Adopting a standardized strategy may improve resource utilization.
https://beat.sums.ac.ir/article_44219_28a8f5620631fb0ecb7070f34dc6286e.pdf
2013-07-01
112
115
Tracheostomy
Early tracheostomy
Airway management
Intensive care unit (ICU)
Mechanical ventilation
Bijan
Ziaeian
1
Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Sedigheh
Tahmasebi
2
Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Hadi
Niakan
hadiniakan@yahoo.com
3
Trauma Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
LEAD_AUTHOR
Afsoun
Fazelzadeh
4
Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
ORIGINAL_ARTICLE
Prognostic Factors for Fournier’s Gangrene; A 10-year Experience in Southeastern Iran
Objectives: To describe the characteristics and prognostic factors of 28 patients with Fournier’s Gangrene (FG) referred to our medical center at Southeastern Iran.Methods: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical Sciences during a 10-year period from April 2002 to March 2012. The study analyzed 9 parameters including the body temperature, heart rate, respiratory rate, hematocrit, white blood count (WBC), and serum levels of sodium, potassium, creatininee (twice for 2 for acute renal failure), and bicarbonate for Fournier Gangrene Severity Index (FGSI) score. The aspects taken into account were age, gender, predisposing factors, duration of symptoms, hospitalization period, and number of debridements, disease outcome and the FGSI.Results: All patients were males, aged from 26 to 68 years, with mean age 44.6 ±8.49 years. Statistically significant differences in age (p<0.001), duration of symptoms (p=0.001), number of debridements (p=0.006), hospitalization duration (p<0.001) and FGSI (p<0.001) were found between surviving and dead patients. The mortality rate was 35.7%, and the most common presentation was perianal/scrotal pain (78.6%). Perianal and primary scrotal abscesses were most common causes of FG and were found in 57.14% and 21.42% of patients respectively. The most prevalent predisposing factor was diabetes mellitus in 12 (42.85%) patients. With respect to laboratory findings, statistically significant differences in WBC (p=0.002), creatinine (p<0.001), albumin (p<0.001), calcium (p<0.001) and serum sodium (p=0.035) were found between the surviving and dead patients.Conclusion: Serious outcome of FG was associated with old age, delayed diagnosis and treatment, inadequate surgical debridement, shorter hospitalization and higher FGSI scores. In addition higher WBC, higher creatininee and serum sodium and lower albumin and calcium levels implicated worse prognosis.
https://beat.sums.ac.ir/article_44220_509858226d1773f206be1b3644ad454c.pdf
2013-07-01
116
122
Fournier’s gangrene
Prognosis
Prognostic factors
Iran
Amene
Sabzi Sarvestani
1
Department of Surgery, Imam-Ali Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
LEAD_AUTHOR
Mehdi
Zamiri
2
Department of Surgery, Imam-Ali Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
AUTHOR
Mehdi
Sabouri
3
Department of Surgery, Imam-Ali Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
AUTHOR
ORIGINAL_ARTICLE
Short-term Outcome of Open Appendectomy in Southern Iran: A Single Center Experience
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26 ± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.
https://beat.sums.ac.ir/article_44221_4986860e236cc6736afa02a2891ba8ca.pdf
2013-07-01
123
126
Acute Appendicitis
Open appendectomy
Short-term outcome
Iran
Shahram
Paydar
1
Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Parisa
Javidi Parsijani
2
Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Armin
Akbarzadeh
armin.akbarzadeh@ymail.com
3
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
LEAD_AUTHOR
Alireza
Manafi
4
Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
AUTHOR
Fariborz
Ghaffarpasand
fariborz.ghaffarpasand@gmail.com
5
Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Hamid Reza
Abbasi
abbasih@sums.ac.ir
6
Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
Shahram
Bolandparvaz
7
Trauma Research Center of Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
ORIGINAL_ARTICLE
One Stage Emergency Pancreatoduodenectomy for Isolated Injury to Pancreatic Head Following Blunt Abdominal Trauma: Case Report and Review of Literature
Major pancreatic injury following blunt abdominal trauma by itself is a relatively rare occurrence, and in vast majority of cases (95%) it is associated with injury to adjacent major vessels and organs; thus making isolated major pancreatic injury even rarer. While most pancreatic injuries are managed by simple measures like debridement and drainage, complex proximal injury poses surgical challenge regarding surgical skill and judgement. Disproportionate approach at any stage of management can contribute to high mortality and morbidity. Emergency pancreatoduodenectomy plays a limited but important role in managing serious trauma to proximal pancreas and duodenum. Author presents a case where isolated injury to head of pancreas required emergency pancreatoduodenectomy. After a bizarre road accident, a middle aged male underwent emergency laparotomy for intraperitoneal bleeding and during exploration a deep transverse laceration with ampullary disruption was found in the head of the organ. Duodenum in all its part was intact and there was no other injury. The nature and site of injury made emergency pancreatoduodenectomy the only viable option. Leaking pancreatojejunostomy enhances infective complications that lead to late mortality. To circumvent this problem there is enthusiasm for staged surgery with resection and tube pancreatostomy in first stage, leaving the difficult anastomosis for a later date, However, if the patient is haemodynamically stable and operated reasonably early, one stage pancreatoduodenectomy gives good result and avoids repeating surgery with inherent problems and reduces hospital stay. For successful management of pancreatic trauma it is essential to make early diagnosis of duct disruption, with sound application of operative skill and judgement by treating surgeon.
https://beat.sums.ac.ir/article_44222_63d2baeef63b03ad3462f83f7c9a27ed.pdf
2013-07-01
127
129
Isolated pancreatic injury
Emergency pancreatoduodenectomy
Major duct disruption
Staged surgery
Associated injury
Sumanta Kumar
Ghosh
1
ESIC Medical College and Hospital, Joka, Kolkata, India.
LEAD_AUTHOR
ORIGINAL_ARTICLE
Profound Bradycardia following Patent Ductus Arteriosus Closure; A Rare but Correctable Event
Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.
https://beat.sums.ac.ir/article_44223_cffda02117aaf6cf366770be86ac84c9.pdf
2013-07-01
130
132
Patent ductus arteriosus
Vagal bradycardia
Surgery
Congenital heart disease
Khalil
Zarrabi
zarrabisx@gmail.com
1
Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran.
AUTHOR
Parsa
Ravanfar
2
Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran.
LEAD_AUTHOR
Azimeh
Azimifar
3
Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran.
AUTHOR
Fariborz
Ghaffarpasand
fariborz.ghaffarpasand@gmail.com
4
Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
AUTHOR
ORIGINAL_ARTICLE
Chest Tube Removal Time in Trauma Patients on Positive Ventilation Pressure: A Randomized Clinical Trial
https://beat.sums.ac.ir/article_44224_e52bc1a69cfa78197e5c24401f22e37e.pdf
2013-07-01
133
134
Chest Tube Removal Time
Trauma Patients
Positive Ventilation Pressure
Mohammad Ashkan
Moslehi
ashkanmoslehi@gmail.com
1
Department of Pediatrics Pulmonology, Shiraz University of Medical Sciences, Shiraz, Iran.
LEAD_AUTHOR