Vol 1 No 1-2 (2014)
Comparison of Methoxyisobutylisonitrile Scintigraphy and Ultrasonography in Preoperative Localization of Secondary Hyperparathyroidism
Background: In patients with secondary hyperparathyroidism, the four glands are not uniformly enlarged; therefore, preoperative localization is difficult in comparison with primary hyperparathyroidism. The aim of this study was to compare the usefulness of 99mTc-sestamibi scintigraphy versus ultrasonography in the preoperative assessment of patients with secondary hyperparathyroidism.
Methods: Between October 2008 and March 2012, 25 uremic patients with secondary hyperparathyroidism underwent 99mTc-sestamibi scintigraphy and high resolution ultrasonography before total or subtotal parathyroidectomy. We measured plasma concentration of intact parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) before parathyroidectomy.
Results: Sensitivity and positive predictive value (PPV), respectively, were 47.3% and 97.8% for MIBI scintigraphy, and 69.5% and 96.9% for ultrasonography. The sensitivity of combined techniques was 84.2%. There was a positive correlation between the parathyroid glands’ weight and serum calcium level, and positive MIBI scintigraphy and ultrasonography results. However, there was no correlation between the preoperative serum PTH, phosphorus, alkaline phosphatase (ALP), dialysis duration, and parathyroid glands’ weight.
Conclusions: Ultrasonography is a reliable non-invasive localization tool. It has greater sensitivity in localizing parathyroid glands in secondary hyperparathyroidism than scintigraphy.
Background: Ectopic pregnancy (EP) is the implantation of fertilized ovum in any site of the reproductive tract except uterine cavity. To choose laparotomy or laparoscopy for treatment is based on the patient’s hemodynamic status, her past surgical history, and the physician’s experience in endoscopic surgery. The goal of this study was to compare clinical and laboratory findings in women who have undergone laparoscopy or laparotomy for EP.
Methods: In this cross-sectional study, 103 women, who had undergone laparoscopic or laparotomy treatment due to EP diagnosis, were enrolled. A structured questionnaire was used to collect information. Past fertility history, past medical and drug history, clinical symptoms and signs, laboratory findings (including Hb and serum β-hCG levels), size of EP mass and its location, endometrial thickness, free fluid in pelvic or abdominal cavity, type of treatment, and method were recorded.
Results: Of the study population, 58 had undergone laparotomy and 45 had undergone laparoscopy. Mean age, mass size, and B-hCG level before surgery were significantly higher in women who had undergone laparotomy. Right tubes followed by left tubes were the most affected sites. Unstable vital sign was recorded in the laparotomy group more than the laparoscopy group.
Conclusions: Results of the current study showed that women who had undergone laparotomy had significantly higher mean age, mass size, and B-hCG level and were more unstable than the laparoscopic group.
Background: Propofol is one of the drugs most commonly used during induction of anesthesia. The induction dose of propofol can lead to hemodynamic changes such as hypotension and bradycardia. Pain on injection is another side effect of propofol. The purpose of this study was to evaluate the effect of two different doses of ephedrine on hemodynamic status and pain on injection of propofol compared to lidocaine and placebo.
Methods: In the present study, 100 patients were enrolled. A 22 gauge cannula was inserted into the veins on the non-dominant hand of all patients. The patients were randomly allocated to 4 groups and 10 ml/kg of saline was administered over 10 minutes from each of the cannulas. Then, patients received either of these pretreatments: 2 ml of Saline (group S); 2 ml lidocaine 2% (40 mg) (group L); Ephedrine (30 ug/kg) (group E1); or Ephedrine (70 ug/kg) (group E2). After 30 seconds all patients were administered 2.5 mg/kg of propofol with a rate of 1 ml per second. The patients were asked to give a score from 0 to 10 (0 = no pain and 10 = most severe pain) every 5 seconds until loss of consciousness. Systolic and diastolic pressures and heart rate were recorded before induction of anesthesia, before intubation, and 1, 3, and 5 minutes after intubation.
Results: Systolic, diastolic, and mean arterial pressure and heart rate following induction in E1 and E2 groups were higher than S and L groups (P < 0.001). There were no differences in systolic, diastolic, and mean arterial pressure and heart rate 1, 3, and 5 minutes after intubation between groups. Lidocaine and both doses of ephedrine reduced pain on injection of propofol similarly.
Conclusions: Lidocaine and high and low doses of ephedrine reduce the intensity of pain on injection of propofol. Small doses of ephedrine attenuate blood pressure and heart rate reduction after induction of anesthesia with propofol.
The Accuracy of Magnetic Resonance Imaging in the Diagnosis of Meniscal and Cruciate Ligament Tears of the Knee
Background: During the past decade, magnetic resonance imaging (MRI) has been accepted as the ideal approach for primary diagnosis of traumatic knee intra-articular lesion. Despite this, the overall diagnostic accuracy of MRI has been carefully scrutinized in Iran. The purpose of this investigation was to scrutinize the diagnostic accuracy of MRI of the knee in identifying traumatic intra-articular knee lesions.
Methods: We compared MRI findings with subsequent arthroscopic findings (as the gold standard) in 107 patients (107 knees) with a clinical diagnosis of traumatic intra-articular knee lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of MRI were calculated based on arthroscopic findings for menisci and cruciate ligaments.
Results: MRI showed the following results for medial meniscus: sensitivity 83%; specificity 37%; positive predictive value 46%; negative predictive value 77%; and accuracy 55%. For lateral meniscus it showed the following results: sensitivity 43%; specificity 86%; positive predictive value 40%; negative predictive value 87%; and accuracy 79%. MRI showed the following results for anterior cruciate ligament (ACL): sensitivity 62%; specificity 90%; positive predictive value 71%; negative predictive value 66%; and accuracy 75%. In addition, it showed the following results for posterior cruciate ligament (PCL): sensitivity 60%; specificity 94%; positive predictive value 42%; negative predictive value 98%; and accuracy 94%. The overall accuracy of MRI was 62.5%. We compared MRI accuracy in two time periods to investigate if there was any improvement over time. Our data showed a significant increase in the accuracy of detection of ACL injuries by MRI in more recent patients; however, there was no improvement in the diagnosis of other internal knee derangements. In addition, overall MRI accuracy was the same in patients from different age groups.
Conclusions: We concluded that the overall accuracy of MRI in diagnosing intra-articular lesions of the knee in Iran is comparable with other published studies in the literature. However, it could be improved; if radiologists and orthopedists work together to find possible flaws, their cooperation would result in optimal use of this diagnostic modality.
Background: Stapes management in tympanosclerosis has always been controversial. There are evidences supporting stapes mobilization, but there are concerns regarding refixation and recurrence of conductive hearing loss; therefore, supporting stapedectomy.
Methods: In this retrospective study, clinical records, operative notes, and audiologic data of patients with stapes fixation (1994–2011) were analyzed. Audiometric findings are reported according to the recommendations of the Committee on Hearing and Equilibrium 1995 Guidelines for the Evaluation of Results of Treatment of Conductive Hearing Loss.
Results: In the present study, 66 patients were enrolled (23 male, 43 female). Stapedectomy and stapes mobilization both had good hearing results (12.1 dB vs. 10.6 dB reduction in ABG) and there was no significant difference. Overall, 63.6% of patients had achieved good results (mobilization: 57.9%, stapedectomy: 71.4%). The difference in success rate between the two groups was not statistically significant.
Conclusions: Stapedectomy and mobilization of stapes both seem to be efficacious and safe in the treatment of stapes involvement in tympanosclerosis. The hearing improvement is long lasting in both procedures.
Despite huge advances in minimally invasive surgeries, efforts still continue for finding less invasive methods of surgery. Patients desire less postoperative pain as well as better cosmetic outcomes. This may be achieved by decreasing the number of laparoscopic ports in which all the surgical maneuvers are performed through a single incision. However, surgeons should be also equipped to act well while avoiding adverse events of the new practicing approach. Along with increasing trends in performing of single incision laparoscopic surgery (SILS) in routine practice, the number of assessing the pros and cons of this new modality is also on the rise. Although it has been claimed that SILS is able to make the dream of invisible laparoscopy true for patients and surgeons, consecutive studies regarding postoperative outcomes questioned the benefits of the new evolved technique. Subsequent meta-analysis also revealed equal outcomes for SILS in comparison to the standard laparoscopy. Our review aimed to outline the pros and cons of SILS.
A 53-year-old man, who underwent total gastrectomy and esophagojejunostomy due to gastric cancer, came back to the emergency ward with delayed intra-abdominal haemorrhage. The patient was suffering from a distended, painful abdomenn. The patient was hypotensive, tachycardic, and oliguric. Laboratory analysis detected severe reduced haemoglobin concentration and coagulopathy. After resuscitation and correction of coagulopathy, the patient was transferred to the operating room. At the emergency operation we found that intra-abdominal haemorrhage was from the transverse mesocolon and site of celiac lymph node dissection. Haemostasis was done by suturing, cauterization, and patches with Surgicel.