Vol 1 No 3-4 (2014)
Prophylactic Oral Calcium Reduces Symptomatic Hypocalcemia in Patients undergoing Total or Subtotal Thyroidectomy: a Randomized Controlled Trial
Objectives: Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy.
Methods: Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups.
Results: The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006).
Conclusions: Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay.
Early Complications Following Bipolar Hemiarthroplasty for Femoral Neck Fracture in Elderly Patients
Background: The femoral neck fracture is one the most important traumatic event in the elderly, because of its high rate and terrible complications. The most frequently used surgical option for the management of displaced intracapsular femoral neck fractures is the bipolar hemiarthroplasty. This study examines the incidence of early complications following bipolar hemiarthroplasty procedures for the management of femoral neck fractures using posterior approach.
Methods: We retrospectively reviewed 1 year follow up of 150 patients with displaced femoral neck fracture who underwent hemiarthroplasty at our institution between 2007 and 2012. Several variables including age, sex, medical comorbidities, type of fracture, operation time, intraoperative complications, hospitalization time, surgical site infection, systemic infection, prosthesis dislocation periprosthetic fracture, pulmonary thromboembolism, mortality and Harris Hip score were examined.
Results: There were 82 males and 68 females in this study. Mean age of patients was 71.4 years. There were no intraoperative mortality, however, one year follow up mortality rate was 7.33%. There were 6.66% early dislocation and surgical site infection was seen in 2.66% of patients. Venous thromboembolic events occurred in 2.66% of patients. The average HHS improved significantly at one year follow up.
Conclusions: Our study showed that bipolar hemiarthroplasty through posterior approach is associated with a modest rate of complications.
Objective: To study the attitudes of Iranian medical nurses towards the do-not-resuscitate (DNR) decision.
Methods: In this cross-sectional study, 200 nurses working in Imam Khomeini Hospital, (affiliated to Tehran University of Medical Sciences, Tehran, Iran) were enrolled. They answered to a questionnaire with two sections: the first one consisted of demographic questions (age, sex, and level of education), and the second included questions about DNR orders derived from a previously conducted study by Hosaka et al.
Results: A total of 168 questionnaires returned (response rate (RR=85%)). About 61% felt that DNR order is sporadically necessary. Near 66% had participated in DNRs in their practice and the most case was the patient with terminal cancer. The most common person who decided DNR orders were physicians. Sixty seven percent believed that DNR cards are useful for establishing in clinical settings.
Conclusion: As DNR is not routine in Iran, enrollment of nurses in this decision should be clearly defined.
Comparison of Remifentanil and Alfentanil Bolus Dose on Extubation Emergence Hemodynamic Profiles, a Randomized Double-blinded Placebo-Controlled Trial
Background: Hemodynamic instability is common during emergence from anesthesia which predisposes patients to development of different side effects. The primary purpose of the present study is to evaluate the effect of Remifentanil and Alfentanil on the hemodynamic profiles during and after extubation.
Methods: Ninety-nine patients aged 20-50 years undergoing minor orthopedic surgery under general anesthesia were randomly allocated into control, Remifentanil and Alfentanil groups. Before extubation patients received Remifentanil (1 μg/kg), or Alfentanil (10 μg/kg) or 5 mL of Saline as a placebo based on their group. Baseline heart rate (HR), mean arterial pressure (MAP) plus systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded and documented again on extubation, and 1, 3 and 5 minutes after extubation. Cough status before and after extubation was recorded.
Results: The basic characteristics of participants in all the three groups were similar. The rise in SBP on extubation in the placebo group was statistically significant compared to the Alfentanil (p=0.01) and the Remifentanil (p<0.001) groups. Mean arterial pressure decreased during the extubation in group R (97.0±13 mmHg) in contrast to other two groups (A=101.9±13 mmHg, P=101.4±13 mmHg). Heart rate increased in group A and P contrary to group R on extubation.
Conclusion: Remifentanil (1μg/kg) and Alfentanil (10μg/kg) attenuate the rise in SBP on extubation but no significant changes were seen between these two drugs.
Background: Endometriosis is a gynecological disorder characterized as the implantation of endometrial tissue outside the uterine cavity. Psychological symptoms such as anxiety, bipolar disorder, depressive symptom and impaired quality of life are common in these women. Sleep quality had not been considered in these women as it should be. The goal of this study was to evaluate sleep quality in women with endometriosis.
Methods: In this cross-sectional study 61 married women with laparoscopically diagnosed endometriosis asked to fill valid and reliable Pittsburgh Sleep Quality Index (PSQI).
Results: Mean age and mean education level were 31.4±6.7 years and 11.7±3.1 years, respectively. Dysmenorrhea followed by dyspareunia was the most common symptoms (68.8% and 40.3%). Mean PSQI score was 6.1±3.4, twenty eight (45.9%) had PSQI score equal or less than 5 and 33 (54.1%) had PSQI score more than 5 (poor sleep). Mean PSQI was significantly different between cases with and without dysmenorrhea and dyspareunia.
Conclusion: Sleep quality should be considered in women with endometriosis.
Outcome of Common Bile Duct Exploration without Intraoperative Cholangiography: a Case Series and Review of Literature
Background: Open or laparoscopic surgical exploration of common bile duct (CBD) is performed when endoscopic approaches fail to extract CBD stones. Intraoperative cholangiography (IOC) through T-tube is performed in order to reduce the rate of retained stones. The aim of this study was to evaluate results of CBD exploration without IOC through T-tube and reviewing existing literature.
Methods: A retrospective medical chart review of 392 patients who underwent surgical CBD exploration was performed. All patients had proven CBD stones and had previously undergone failed attempts of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). T-tube insertion or biliary-enteric anastomosis was performed after open CBD exploration with regard to patient’s presentation and CBD diameter. IOC was not performed after T-tube insertion and cholangiography was postponed until 7th postoperative day. Postoperative retained stone and their management were reviewed.
Results: Of 392 patients with CBD explorations, T-tube was placed in 215 (54.8%) including 66 (30.7%) emergent biliary drainage and 149 (69.3%) elective operations. A number of 177 of 392 (45.2%) patients underwent biliaryenteric anastomosis. In 6 of 215 patients (2.8%) with T-tube placement, retained CBD stones were detected by T-tube cholangiography during postoperative period. All of them were treated successfully by ERCP.
Conclusions: T-tube placement without IOC is accompanied by a low rate of retained stone. Omitting IOC may decrease the operation time which is especially important in emergent cases. Retained stones following CBD exploration and T-tube placement can be treated successfully using ERCP.
Posterior Surgical Approach for Cervical Fracture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: A Case Report
Background: To explain posterior approach for a case with vertebral fracture caused by trauma in a patient with diffuse idiopathic skeletal hyperostosis (DISH) and evaluation its outcome and effects.
Case Presentation: A 57 years-old man came to emergency room due to falling and severe cervical pain. The patient was neurologically intact and radiological surveys revealed fractures in C6 cervical vertebrae in addition to hyperostosis in the lumbar and thoracic spine. We fixed fractured vertebra by lateral mass screws through a posterior approach with bony fusion (without laminectomy).
Results: The patient was mobilized the day after operation and discharged from hospital 3 days later. One year follow up showed acceptable bony fusion and no complication was reported.
Conclusions: Posterior approach is an effective and simple procedure in comparison to other approaches and can be used safely with minimal side effects in selected patients with DISH.