Vol 5 No 1-2 (2018)
Comparison of the Efficacy of Oral Simvastatin and Topical Simvastatin Solution in Decreasing Post-Laparotomy Adhesions in Rats
Background: Intra-abdominal adhesions and their complications occur frequently after laparotomy. The aim of this study was to compare oral versus intraperitoneal administration of simvastatin in decreasing postlaparotomy adhesions in rat.
Methods: Thirty male Wistar albino rats were divided into three groups of ten. All the rats underwent laparotomy and induction of adhesions using the method of Meso-Stitch approximation of injured cecum and abdominal wall. One group received oral simvastatin (40 mg/kg) daily during two weeks before the laparotomy. In the two other groups, 2 ml of solution of simvastatin (40 mg/kg) or distilled water (as placebo) was spilled into abdomen before closing abdominal wall, respectively. After 14 days, all the rats were put under laparotomy again to be compared. Rates and grades of adhesions were assessed using Hoffman et al. and Lauder et al. Scale and histopathological reports.
Results: In placebo group, the grade II and III adhesion was seen in 2 and 8 rats, respectively. In local simvastatin group, there was no adhesion in 5 rats, and grade I and II adhesion was seen in 3 and 2 rats, respectively. In oral simvastatin group, 6 rats were without adhesion, and 3 cases with grade I and 1 case with grade II adhesion. The frequency and grade of adhesion were statistically different in simvastatin groups compared to the placebo group (P < 0.001), but not with each other.
Conclusions: Oral simvastatin for two weeks before the laparotomy can reduce post-laparotomy adhesion bands as well as local administration of simvastatin solution.
The Outcomes of Left Thoracotomy and Esophagogastrostomy Method in Patients with Esophageal Cancer in Babol City, Northern Iran (2004-2011)
Background: Since esophageal cancer is highly prevalent, and has a high cost for patients and society, this study aimed to investigate the result of surgery in esophageal cancer with esophagogastrostomy method to lower the problems of these patients.
Methods: In this cross-sectional study, all patients who were diagnosed with esophageal and upper gastric cancer with surgical indications during 2004 to 2011 in Shahid Beheshti hospital, Babol City, Iran, participated. Patients then underwent esophagogastrostomy surgery. Patients’ data were gathered using a survey and analyzed using t and chi-square tests via SPSS software. A P-value of less than 0.05 was deemed statistically significant.
Results: A total of 47 patients who were confirmed as having esophageal cancer by pathologic evaluation, were investigated. A significant relationship was observed between body mass index and complications after surgery (P = 0.04). 57.1% of underweight patients and 100% of obese patients experienced complications. No significant relationship was seen in other factors. The average age of patients who experienced complications was higher than those who reported no complications, and the difference was statistically significant (P = 0.03). Moreover, the duration of surgery was significantly higher in patients with complications (P = 0.01).
Conclusions: It would seem that complications after surgery were higher in underweight patients and the duration of surgery was higher in these patients. No significant relationship was seen in other factors.
The Reliability and Effectiveness of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Head and Neck Module (EORTC QLQ-H&N35) in Head and Neck Cancer
Background: We aimed to test the validation of the European organization for research and treatment of cancer (EORTC) quality of life questionnaires for head and neck module (QLQ-H&N35) in a tertiary care center.
Methods: Forty patients with head and neck malignancy completed the QLQ-H&N35 while undergoing their treatment. Questionnaires given to them were translated into their regional language Kannada. Evaluation of the responsiveness, reliability, and validity of the questionnaire was undertaken.
Results: The data assessed the reliability of the scales and not validity. The questionnaire was receptive to changes over time; however, the applicability of the European questionnaire in Indian clinical set up was debatable.
Conclusions: Our data suggests that the EORTC QLO-H&N35 is reliable and responsive when applied to patients with head and neck cancer in India. Hence, it may be used as a platform to test validity at a multicentric level.
Bacteriology of Surgical Site Infections and Antibiotic Susceptibility Pattern in Isolates of Postoperative Wound Infections
Background: We aimed to evaluate the isolates of postsurgical infections, and study their sensitivity; so that strategies could be made by using proper antibiotic treatments.
Methods: Study isolates were obtained by swabs/pus from the subjects reported for surgical site infections (SSIs) at surgery department of a governmental tertiary care hospital, Nagpur, India, and were further transferred to the pathology department during the period from June 2009 to November 2011. About 250 cases of surgical site infection were evaluated with isolates form different surgical sites which were surmised to be infected based on clinical evaluation. The isolates were subjected to standard procedures, and antibiotic susceptibility test opting modified Kirby-Bauer disc diffusion technique.
Results: Twelve types of organisms were isolated; most common was Klebsiella species (23.7%), Staphylococcus aureus (20.00%), followed by Escherichia coli (15.1%), Pseudomonas aeruginosa (13.4%), coagulase-negative staphylococci (CoNS) (11.0%), etc. Results suggested 50% of the isolates having Staphylococcus aureus were resistant to methicillin. More than 60% of isolates having Escherichia coli and Pseudomonas aeruginosa were resistant to gentamicin. The number of isolate showing resistance to 3rd generation cephalosporins and the quinolone antibiotics was high.
Conclusions: Surgical site infections crowded with multi-resistant organisms, not only increase the economic burden in the form of antibiotics, but also pose a serious threat to patients undergoing surgery. To avoid such infections, there is an urgent need to follow aseptic and sterilization techniques, also rationale use of antibiotics has to be done.
Background: Basidiobolus ranarum is a fungus that usually causes subcutaneous infection. Medical literature rarely report gastrointestinal involvement, especially in tropical climate areas.
Case Report: Here we report a case of gastrointestinal basidiomycosis in an immunocompetent 43-year-old man from south of Iran who presented with abdominal pain, loss of appetite, and nausea. He had history of previous laparotomy 10 years ago, because of perforated peptic ulcer. He underwent an exploratory laparotomy. We found a mass in ascending colon; so, right hemicolectomy were done. Histologic founding were amazing. Eosinophilic sheath surrounding hyphae-like structures was seen. The diagnosis of basidiomycosis was established, so we prescribed antifungal agents for the patient. He expired 6 months later according to disseminated disease.
Conclusions: Gastrointestinal basidiomycosis is a rare and invasive fungal infection that imitates malignant tumors, inflammatory bowel disease, or even phlegmon of appendicitis. Diagnosis of gastrointestinal basidiomycosis needs a high index of suspicion. The physicians should be aware of this disease as differential diagnosis in tropical areas. Surgical resection and prolonged antifungal therapy is recommended, but in some cases, the disease may spread and cause death.
Background: Abdominal aortic aneurysm (AAA) is one of vascular surgery challenges, because of its differences in decision making about time and type of surgery (open vs. endovascular).
Case Report: We have case of patient with old pulmonary tuberculosis came with recurrence of AAA after open surgery. We decided to perform endovascular treatment, but there was an anatomical difficulty for device selection.
Conclusions: Although recurrence of AAA is rare, it has more diagnostic and therapeutic challenge. Recurrence after open surgery occurs less than endovascular surgery. Treatment after open surgery is better to conducted with endovascular manner, because of general condition of patient and probable difficult abdomen due to adhesion of previous laparotomy.
Background: Syndactyly, as one of the most common congenital hand abnormalities, requires surgical repair according to various approaches.
Case Report: We report a 28-year-old man with simple syndactyly in his third web.
Conclusions: The common concern is about skin defect coverage, and we illustrated in a mathematical objective survey, if distance between to phalanxes’ center was more than 1.5 times diameter (each of phalanxes), then there would not necessary to use skin graft.