2023 CiteScore: 0.7
pISSN: 0044-6025
eISSN: 1735-9694
Editor-in-Chief:
Ahmadreza Dehpour, PharmD, PhD
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 49, No 4 (2011)
Articles
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The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.
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To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs). METHODS: In this randomized controlled trial,80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg-1 was administered, followed by intravenous alfentanil 20 µg.kg-1, lidocaine 1.0 mg.kg-1, and propofol 2 mg.kg-1 sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465). Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P<0.001). Although mean arterial blood pressure increased immediately after intubation in the Macintosh group (P=0.022), its post-intubation values were significantly less than baseline in both groups (P<0.001). Intubation time took much longer in the Bonfils group (40 s) than the Macintosh group (11 s), P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time.
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To compare the efficacy of acupressure wrist bands, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery. Two hundred patients, ASA physical status I or II, aged between 10 and 60 years, undergoing strabismus surgery in Farabi Hospital in 2007-2008 years, were included in this randomized, prospective, double-blind and placebo-controlled study. Group I was the Control, group II received metoclopramide 0.2 mg/kg, group III received ondansetron 0.15 mg/kg iv just before induction, in Group IV acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I, II and III. The acupressure wrist bands were applied 30 min prior to the induction of anesthesia and removed six hours after surgery. Postoperative nausea and vomiting (PONV) was evaluated within 0-2 hours and 2-24 hours after surgery by a blinded observer. Results were analyzed by X2 test. A P value of < 0.05 was taken as significant. The incidence of PONV was not significantly different in acupressure, metoclopramide and ondansetron during the 24 hours. Acupressure at P6 causes a significant reduction in the incidence of PONV 24 hours after strabismus surgery as well as metoclopramide 0.2 mg/kg and ondansetron 0.15 mg/kg iv for patients aged 10 or more.
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Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male (male to female ratio: 5 to 1) with the mean age of 36 ± 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 ± 22.4 cells/µl. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 ± 15.5 cells/µl and there was a significant association between CD4 count and rate of toxoplasma encephalitis (P<0.001). Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIVinfected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran.
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Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma in children. The aim of study was to retrospectively review the treatment results of childhood rhabdomyosarcoma and identify prognostic factors. 60 children with rhabdomyosarcoma treated between 1996 and 2002 in Shafa Hospital were reviewed. The data were analyzed for clinico-epidemiological factors. Age, gender, race, histology type, primary site, tumor size and intergroup rhabdomyosarcoma study (IRS) group were evaluated. The primary site of involvement was orbit in 6 cases (10%) head and neck nonparameningial in 12 cases (20%), parameningial region in 12 cases (20%). The histological findings were as follows: 12 cases (72.5%) for embryonal, 6 cases (10%) for alveolar and 11 cases (17. 5%) for botryoid type. With respect to the IRS III (15%) were group II, 32 (52.5%) were group III and 24 cases (40%) were group IV. The 5-year survival rate was 47.9%. Primary tumor site (P=0.0003), and histology (P=0.05) were associated significantly with survival after recurrence. Among the variables, age, gender, regional lymph node involvement, and IRS group did not affect 5-year survival but the type and time of recurrence (P=0.0002), and its relation with therapy (P=0.0001) were associated with survival. This study showed that overall survival for rhabdomyosarcoma is dependent on histological subtype, primary site, disease group, duration of disease before treatment. The outcome for infant with RMS is less satisfactory than older children and the patients aged 1-9 years had the best 5 year survival.
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The typical features of eccentric exercise-induced muscle damage is prolonged loss of muscle strength and the most rapid structural change in the fibers is loss of immunostaining for the intermediate filament protein, desmin. In this study isolated perfused rat muscle was used to examine the direct effect of temperature changes on the eccentric contraction-induced force and desmin loss. The left medial gastrocnemius muscle was separated and the entire lower limb was transferred into a prewarmed (35o C) organ bath. Temperature was adjusted to 31 or 39o C during and after eccentric contractions. Maximal isometric force and desmin loss were measured after 15 isometric or eccentric contractions. According to our data, organ bath temperature changes during or after eccentric contractions had no significant effect on force loss. However, a strong correlation between desmin loss and temperature changes during (r = 0.886, P< 0.05) and a weak correlation between desmin loss and temperature changes after (r= 0.699, P<0.05) eccentric contractions was observed. Our results suggest that cooling during eccentric contractions may decrease desmin loss but temperature changes after eccentric contractions have no effect on desmin loss.
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Sulfur mustard gas is one of the chemical warfare gases that roughly about 45000 soldiers continue to suffer long-lasting consequences of exposure during the Iran-Iraq war between 1980 and 1988. According to the common pulmonary lesions due to this gas exposure, we studied gross and microscopic pulmonary lesions in cadavers and also assessed the main causes of mortality caused by mustard gas exposure. A case-series study was performed on hospital record files of 100 cadavers that were exposed with documented sulfur mustard gas during the Iran-Iraq war from 1979 to 1988 and autopsied in legal medicine organization In Tehran between 2005 and 2007 and gross and microscopic pathological findings of autopsied organs such as hematological, pulmonary, hepatic, and renal changes were evaluated. All cases were male with the mean age of 43 years. The time interval between the gas exposure and death was almost 20years. The most frequent pulmonary complication was chronic bronchitis in 81% of autopsied cadavers. Other pulmonary findings were progressive pulmonary fibrosis (9%), pulmonary infections and tuberculosis (29%), malignant cellular infiltration (4%), and aspergilloma (1%). According to the chronic progressive lesions caused by mustard gas exposure such as pulmonary lesions and also its high mortality rate, suitable programming for protection of the gas exposed persons and prohibiting chemical warfare are recommended.
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Soft tissue defects of the lower limb are a challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. This study has been conducted as a descriptive study. The arterial blood supply of the soleus muscle was studied in 45 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The mean length of the soleus muscle was 37 ± 2.2 Cm. In 66.7% of the limbs at least two branches arose from the popliteal artery trunk. The average distance of the first branch was 2.61 ± 1.75 Cm distal to the fibular head. And the second branch was 3.88 ± 0.7 Cm distal to the fibular head. The average number of branches to the soleus muscle from the posterior tibial trunk was 4.3 ± 0.7. The average distance of the first branch was 9.4 ± 2.3 Cm from medial malleolus and second branch was 15 ± 3.4 Cm. The average number of branches to soleus arising from the proneal artery was 3.8 ± 0.8. The proneal artery gave 2-5 branches to the soleus muscle in the limbs that in 95.6% of the limbs were found three branches from proneal artery trunk to soleus muscle. In this study have been shown, the distribution of the arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. However, clinical application of distal pedicle soleus muscle flaps in Iranian population is not beneficial and we do not recommend it to the surgeons.
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We prepared this study to determine the effect of cryoanalgesia on post-thoracotomy pain. In this double-blinded randomized clinical trial, 60 patients who underwent thoracotomy were divided into two groups (control and cryoanalgesia). Visual Analogue Scale (VAS, 0-10) was used for the measurement of severity of post-thoracotomy pain. It was classified into three categories: 0-1 (mild), 2-3 (moderate), and 4-10 (severe). Pethidine (0.5-1 mg/kg) was administered in case of need for both groups. Patients were visited at the hospital a week later, and were contacted by phone at the first, second, and third months post-operatively. Intensity of pain in the control group was higher than the cryoanalgesia group in all visits the follow-up period. On the second day, the frequencies of severe pain (4-10) were 33.3% and 0 in the control and cryoanalgesia groups, respectively. The mild pain on the seventh day was 13.3% and 83.3% in the control and cryoanalgesia groups, respectively (P < 0.01). Pethidine consumption was 151.6 ± 27 mg in the control group and 87.5 ±48 mg in the cryoanalgesia group on the first day post-operation (P < 0.001). Cryoanalgesia is a useful technique with not serious side effects in order to alleviate post-thoracotomy pain and reduce the need for opiate consumption.
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Over the past few decades, quality of life (QOL) has become an important concept in medical researches and treatments. Different meaningful reasons are given for this development. In the current research two standard questionnaires for evaluating of QOL were selected. First one, was a questionnaire from The World Health Organization (WHOQOL-BREF 26) and the second one, The Iranian Diabetics’ Quality of Life (IRDQOL). The goal of this study is to assess the relation between different domains of these questionnaires and HbA1c in diabetics. A random sample of Iranian adult outpatient diabetics (n=76) was selected and they completed the WHOQOL and IRDQOL assessment instruments. In addition HbA1c was measured in these patients by calorimetric method. Comparisons were made between scores of “questionnaires’ domains” and “HbA1c”. Data analysis was carried out by the use of T-test, Spearman correlation coefficient, Pearson’s correlation coefficient, and non-parametric statistical methods including Spearman correlation coefficient. Data analysis shows Psychological domain score in IRDQOL is lower than in WHOQOL and it is significant (P<0.0001). Physical domain score in IRDQOL is lower than WHOQOL and it is significant (P<0.0001). In WHOQOL questionnaire, analysis data showed when the patient’s age increased, physical and psychological domain’s score decreased. There is probably no relation between questionnaire domains and HbA1c in diabetics. Based on the findings in this research, there was obviously almost no difference between the two questionnaires for checking the QOL, but in IRDQOL spiritual domain is a very unreliable domain.
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We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B (HBsAg, anti-HBc, anti-HBs) and Hepatitis C (anti-HCV) markers, during 2004- 2005. HBsAg was positive in 27 patients (13.4%), anti-HBc was positive in 60 patients (29.8%) and anti-HBs in 23 patients (11.4%). Anti-HCV Ab was positive in 135 of 201 (67.2%). HBV and HCV coinfection was observed in 73 of 201 (36.3%). The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively (P<0.0001). The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients´wife (HIV+ patients who were infected by monogamous sexual contact with their HIV positive husband) both of them were 8% (P<0.0001). This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran.
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It has been reported that selective serotonin reuptake inhibitors (SSRIs) possess some cardiac effects. In the present study we have investigated the effect of paroxetine (PX), a potent SSRI agent, on spontaneously as well as ouabain-induced arrhythmia beating isolated guinea-pig atria. The Guinea-pig heart was rapidly removed; the auricles were dissected out in oxygenated modified Krebs solution. The rate and force of spontaneous contractions were recorded isometrically with a photosensitive transducer. PX (1-16 µg/ml) caused a dose-dependent decrease in the rate of contractions (14-70%) and contractile force (8-16%). Ouabain alone (1.2 µg/ml) produced arrhythmia at 7.2 ± 1.5 min and asystole at 20.1 ± 3.1 min. Pretreatment with PX (4 µg/ml) significantly increased the time of arrhythmia onset to 19.8 min. In addition, PX prolonged the duration of action beating from 20.1 ± 3.1 min to 43.1± 2.6 and delayed the occurrence of asystole. The pattern of contractile force by PX + ouabain treatment was more regular than that observed after administration of ouabain alone. The above findings may the probably be due to the inhibition of cardiac Na+ and Ca2+ channels or autonomic nervous system. Results also suggest that PX may reduce the membrane conductance through inhibition of ionic channels to prevent ouabain-induced arrhythmia.
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Echinococcosis, although eradicated in many countries, is still widespread in communities where agriculture is dominant. Cystic hydatidosis is a significant public health problem in the regions with endemic echinococcosis. The hydatid cysts tend to form in the liver or lung, but may also be found in other organs of the body such as brain, heart, and bone, while thyroid gland involvement is rather rare. A 25 year old male presented with solitaire goiter. Laboratory tests and thyroid profile proved normal. Surgical exploration revealed hydatid cyst in the left lobe of the thyroid gland. Examination of the nodule showed it to be a solitary primary thyroid hydatid cyst.
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Osteoid osteoma is a small benign bone tumor usually affects adolescents and young adults. Although this tumor mainly affects the shafts of long bones there have been several reports of subperiosteal and intramedullary involvement .Complete surgical excision is the classic treatment of choice for patients with osteoid osteoma. Despite the small size of the tumor, the operative procedure for its removal can be extensive .The surgeon may have to excise a significant piece of bone to be sure the lesion is removed. There is a risk of fracture if a large amount of bone is removed and therefore internal fixation, bone grafting, or both may be required. In recent years several techniques of minimally invasive treatment of osteoid osteoma have been proposed. We introduce intramedullary reaming as a minimally invasive procedure for the treatment of intramedullary osteoid osteoma in long bones.
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Cholelithiasis is a rare but known complication of surgery for duodenal atresia. Occurrence of choledocholithiasis as sequelae of duodenoduodenostomy is still rarer. Biliary stasis resulting from compression of common bile duct due to periductal fibrosis may predispose to gallstone formation. We are reporting a case of choledocholithiasis in a 6 year old child as a late post-operative complication of duodenoduodenostomy (for duodenal atresia in the neonatal period). To the best of our knowledge this is the first case of its kind reported in English literature. Cholecystectomy followed by choledocholithotomy was done and the patient had an uneventful recovery. Upper abdominal pain in any patient with a history of surgery for duodenal atresia in the past warrants a thorough evaluation for any biliary tract anomaly, cholecystitis, cholangitis, cholelithiasis or choledocholithiasis.
