Academic Journal of Surgery

Surgical Never Events: A retrospective study in Iranian Hospitals

2024-11-02T05:29:44+0330

Background: Never event is an unintentional injury or complication that increases the length of hospital stay, disability at the time of discharge or death due to improper health care management. Adverse events are potentially preventable in terms of patient injury, increasing the length of hospital stay, and increasing health care costs. Due to the importance of the subject, the present study was conducted to investigate the factors related to adverse surgical events in Iranian hospitals in 2020.
Methods: This cross-sectional study (descriptive-analytical) was conducted to determine the factors associated with adverse events related to surgery in Iranian hospitals. All reports entered in the unwanted events registration system related to codes 1, 2, 3 and 4 of unwanted surgical events from March 2018 to March 2021 were included in the study.
Results: The results showed that the rate of surgical Never events in Iranian hospitals is about 0.006%. The highest incidence of unwanted surgical events in error code 4 (leaving any device including gas, scissors, pliers, etc. in the patient's body) with 63.7% and the lowest incidence of adverse surgical events in error code 2 (performing surgery incorrectly on another patient) was 4%.
Conclusions: The findings of the present study show that the rate of unwanted surgical events in Iranian hospitals is lower than the global average. Lack of a precise framework for job descriptions and responsibilities, failure to use instructions, and lack of decision support systems are all factors in the occurrence of adverse surgical events.

Pleural and Primary Mediastinal Complications and Treatment of COVID-19 Patients

2024-11-02T05:29:44+0330

The persistent disease 2019 (COVID-19) presents prodigious challenges for research and medical research, mainly with specific epidemiological and clinical characteristics. Patients with COVID-19 pneumonia may have conditions ranging from clinical, and asymptomatic to death due to respiratory failure. COVID-19 pneumonia may be associated with pleural complications such as pneumothorax (PT), pneumomediastinum (PM), pleural effusion, and empyema. To investigate primary Pleural and Mediastinal Complications (PPMCs) and how to treat them in patients with COVID-19. In this cross-sectional study, 10,000 patients with COVID-19 were investigated for the incidence of mediastinal and pleural effusions between the beginning of the second half of 2019 and the end of the first half of 2019. In this study, the average age of patients with PPMCs was 54.29 ± 14.69. 62% (124 patients) were male and 38% (76 patients) were female. In this study, among 10.000 patients with Covid-19, 600 patients (6%) had pleural effusion, of which 456 (4.56%) had mild pleural effusion, and 144 (1.44%) had moderate to severe pleural effusion. Frequency of PPMCs in COVID-19 patients: 0.53% (53 cases) PT, 0.09% (9 cases) hemothorax, 0.06% (6 cases) empyema, 0.96% (96 cases) PM, 0.12% (12 cases) pericardial effusion, 0.17% ( 17 cases) of atelectasis, 0.04% (4 cases) of emphysema were reported. The most frequent pleural complication was pleural effusion, with a frequency of 6%, and the second rank of complications was related to PM, with a prevalence of 0.96%. Being elderly was strongly associated with the rate of intubation and mortality in the hospital (P<0.05). No significant relationship existed between patients' age and PPMCs (p>0.05). There was no significant difference between PPMC in men and women (p>0.05). The results of our study show that PPMC in patients with COVID-19 has a low prevalence, and if they do occur, the most frequent are related to pleural effusion and PM.

Evaluation of Brain CT Findings in Patients with Head Trauma Visiting Khatam Al-Anbia Hospital in Zahedan in 2022

2024-11-03T09:01:02+0330

Background: Traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability. This study aims to evaluate brain CT scan findings in patients with head trauma admitted to Khatam al-Anbia Hospital in Zahedan during 2022.
Methods: This cross-sectional, descriptive-analytical study focused on patients presenting with head trauma at Khatam al-Anbia Hospital in Zahedan throughout 2022 who underwent brain CT scans. A census-based sampling method was employed, and data were collected using a structured checklist. The analysis was conducted using SPSS software.
Results: The study included patients with a mean age of 51.78 ± 26.75 years, ranging from 1 to 99 years. Among the 100 participants, 25 (25%) were women and 75 (75%) were men. The highest incidence of TBI was observed in the 70 to 80-year age group, with 15 patients, whereas the lowest incidence was found in the 50 to 60-year and over 90-year age groups, with 6 patients each. Car accidents were identified as the leading cause of head trauma, accounting for 32 cases (32%), followed by physical altercations, which contributed to 10 cases (10%). CT scan results indicated that 10% of the scans were normal, while 90% were abnormal. Notable abnormal findings included subdural hemorrhage (6 cases), frontal bone fractures (16 cases), and cytotoxic edema (6 cases). The most frequent location and type of skull fractures were in the temporal region (8 cases, 29.6%) and

linear fractures (16 cases, 59.3%), respectively. The majority of TBIs were classified as mild (54 cases), with moderate TBIs being the least common (16 cases). Additionally, significant associations were found between injury type, gender, and the nature of the trauma.
Conclusions: This study highlights that road traffic accidents are a predominant cause of traumatic brain injuries, consistent with findings from various studies. The most frequently affected age group was 70 to 80 years, with a predominance of men. Abnormal CT findings commonly included subdural hemorrhage, frontal bone fractures, and cytotoxic edema. These results indicate potential regional differences in TBI patterns and emphasize the importance of targeted diagnostic and treatment strategies. The findings underscore the need for early and precise CT imaging in managing head trauma to improve patient outcomes. Further research is essential to refine management approaches and address regional variations in TBI.

A rare case of pneumothorax caused by ruptured pulmonary hydatid cysts accompanied by deep vein thrombosis: A Case Report

2024-11-02T05:29:44+0330

Hydatid disease is mostly found in endemic areas such as middle east, particularly in patients with certain history of exposure. Signs and symptoms depend on the organ infected by the cysts, as hepatic cysts may cause abdominal pain and jaundice. Pulmonary hydatid cysts on the other hand, usually occur in the lower lobe of the right lung, and present with chest pain, cough, or shortness of breath. Rupture occurs in about one third of patients, releasing a highly antigenic fluid, which can result in anaphylaxis when ruptured into the bronchus. Alternatively, although not common, pulmonary hydatid cyst rupture may result in pleural effusion or rarely, pneumothorax. Our patient was a young man presented with pneumothorax resulted from a ruptured pulmonary hydatid cyst and concurrent extensive DVT. The cysts were completely resected, and underlying parenchyma was repaired through a posterolateral thoracotomy, while DVT was managed by anti-thrombotic therapy.

Dermatofibrosarcoma protuberans of the face: A case report

2024-11-02T05:29:44+0330

Introduction: Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive tumor with high rate of local recurrence but low metastatic potential. Its occurrence in the head and neck is a rare finding but it is associated with increased morbidity and mortality.
Case report: A 53-year-old Iranian man referred to a complaint about an increase in the size of the subcutaneous mass on the right cheek that had been present since he was 17 years old. On clinical examination, the lesion was not painful and had no erythema. In examining the patient's CT scan without contrast, a mass-like area with soft tissue density was seen. During the surgery, the flap was lifted after a lateral rhinotomy incision. The biopsy sample was sent for frozen section, and the pathology result was a Spindle cell tumor. In immunohistochemistry (IHC), two factors, including CD34 and VIMENTIN, were positive and Dermatofibrosarcoma protuberans (DFSP) was reported.
Conclusion: The most important prognostic factor for surgery of Dermatofibrosarcoma protuberans is obtaining tumor free surgical margins. As a result, accurate diagnosis and correct management of this uncommon and locally invasive malignancy is very important, especially in head and neck surgery.

My first two rhinoplasty surgeries as main operator: Personal experience and considerations by a 2nd year plastic surgery resident

2024-11-02T05:29:44+0330

In the present paper, my first two rhinoplasty cases performed as a second-year plastic surgery resident will be presented. The morpho-functional analysis of the patients’ noses, the operative procedures, and the results will be described, highlighting the technical and organizational difficulties encountered and the strengths/safety points. The goal is to help young colleagues like me become acquainted with this complex surgery, characterizing possible initial obstacles and areas for improvement.