Vol 2 No 3-4 (2015)
Hand surgery literature is full of disease names and terms. Some of them are misnomers, which are misleading to physicians outside the specialty. Therefore, we decided to collect all misnomers and provide them via this paper. Considering development of sciences in future, perhaps avoidance from new misnomers is impossible, but awareness of this fact, lead us to be more ingenious in interpretation. On the other hand, we believe his collection would be interesting for most specialists in hand surgery and as well informative for others.
Readmission Risk Factors in Patients of General Surgery Wards in Shiraz Hospitals: Applying LACE Index as a Predictive Indicator
Background: Today, the effective use of limited health care resources is increasingly regarded. Reduction of the readmission is one of the key tools can improve health outcomes and considered as one of the control levers that reduces health costs. Identifying the causes of readmission to the hospital helps to utilize hospital beds and facilities a more efficiently.
Methods: This case-control study had been conducted in general surgery (GS) wards in 2011-2012. Using chisquare test, t-test, and multiple regressions, we studied risk factors associated with readmission in both groups of case and control. Finally, the predictive power of the Length of stay, Acuity of illness, Co morbidity of the patient, Emergency (LACE) index was evaluated using receiver operating characteristic (ROC) curve.
Results: About 20% of patients in GS wards were admitted within 30 days. There is a significant difference between the two groups in the following variables: age, sex, length of hospital stay, marital status, discharge season, congestive heart failure, diabetes and renal failure. The rate of readmission with LACE index which is compared with the ROC curve shows that it is significant (P < 0.001 and Kappa = 0.22).
Conclusions: Awareness of the prevalence and risk factors of readmission is effective in planning and decision making for using hospital facilities efficiently. Identifying patients at risk of readmission and erforming training plan, ischarging and following up medical programs can reduce the rate of readmission and costs of hospital. Predicting readmission can be very effective but identifying an effective index is very difficult.
Comparison of Complete Sinus Excision and Reconstruction with Sinus Excision and Umbilical Preservation for Treatment of Umbilical Pilonidal Sinus
Background: Umbilical pilonidal sinus is a granulomatous reaction to hair shaft penetrating the epidermis of umbilicus from the external surface. In this study, the outcome of complete excision of the umbilical sinus with umbilical reconstruction and sinus excision with umbilical preservation is considered.
Methods: This study was a clinical trial. In this study, 60 subjects with umbilical pilonidal sinus were enrolled into two groups (Group I, complete excision of the umbilical sinus with umbilical reconstruction, n = 30, Group II, sinus excision with umbilical preservation n = 30). Discharge, bulging, pain, bleeding, and itching of umbilicus and existence of hair were registered in the base visit and then 1 and 2 weeks, and 1, 3, and 6 monthslater. Patients with umbilical pilonidal sinus, who had not undergone any previous surgeries, were operated on using a technique that involves complete excision of the umbilical sinus followed by reconstruction of the umbilicus or sinus excision with umbilical preservation. Patients were then followed and wound complications,and recurrence were evaluated at post-operative visits (1 week, 2 weeks, 1 month, 3 months, and 6 months later). Remission and relapse of each symptom were compared. Data were analyzed by SPSS version 16.
Results: A total of 60 patients underwent the operation; 55 (91.7%) were male, and 5 (8.3%) were female. The mean age in Group I, complete excision of the umbilical sinus with umbilical reconstruction was 29.9 years (18-45 years) and mean age of Group II, sinus excision with umbilical preservation was 28 years (19-42). Themean follow-up period was ٦ months. Only one patient in Group I, complete excision of the umbilical sinus with umbilical reconstruction had seroma and hyperemia of the skin after the operation, and treated conservatively at an outpatient clinic. No recurrence was observed during the follow-up period, and the most patients were satisfied with the appearance of their umbilicus. The two groups were not different by the meansof age, sex and symptoms at baseline (P > 0.050). Remission of symptoms were not significantly different inthe two groups (P > 0.050). The probability of relapse of other symptoms were not different in two groups (P > 0.050).
Conclusions: Umbilical sinus excision with umbilical reconstruction is a relatively simple and effectivesurgical option for treating umbilical pilonidal disease with acceptable patient satisfaction and no serious complications. It may also be associated with a low risk of recurrence.
The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department
Background: Pain could potentially affect all aspects of patient admission course and outcome in emergency department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually, and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments.
Methods: In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in pain patterns regarding different aspects of trauma injuries in these two groups were compared.
Results: The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a supplementary pharmacological intervention.
Conclusions: Pharmacological management of pain in patients with trauma is shown to be significantly beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain management of patients with trauma.
Design and Evaluation of the “Preparation Course for New Entrant Assistants” on the Awareness and Skills of Newly Arrived Surgery Resident
Background: Beginning of assistance course is associated with anxiety. This due to unfamiliarity with the assistance and insufficient training, knowledge, and required skills. The aims of this study were to design, implement and evaluate the effects of a period of 1-month as “preparation course for new entrant assistants” on the awareness and skills of newly arrived residents.
Methods: 12 newly arrived assistant student were divided into two equal groups. Some steps such as understanding the environment and legislation, education about an emergency, and dealing with patients and also, suturing, chest tube insertion, and cut down skills were passed by the first group before starting the assistance course. The second group was entered in the assistance course without this preparation course. For performance evaluation and comparison of these two groups, four questionnaires were created and filled consequently before the entrance, at the end of the 2nd month, based on direct observation of procedural skills (DOPS) exam, and at the end of 6th month.
Results: There were no significant differences between two groups at the beginning of the study (P < 0.05). At the end of the 2nd month, the first group had better performance in understanding the environment, patient examination, diagnosis and emergency skills in comparison to the second group (P < 0.05). Based on the DOPS score, the first group had significantly better performance (P < 0.05) except in performing cut-down (P > 0.05). Also procedure, the first group was better than the second group just in the consensus of the procedure (P < 0.05). Finally, at the end of the 6th month, the difference between two groups was becoming lower, and supervisors believed that after additional 3 months, this difference would be lost.
Conclusions: Conducting a 1-month period of preparation for new entrant assistants can be useful in increasing awareness, understanding the environment, performance, the knowledge of the theory and how to deal with patients as well as increase their skills in performing the expected procedures.
The Effect of Premedication by Remifentanil and Magnesium Sulfate in Hemodynamic Responses to Tracheal Intubation in Cesarean Section Delivery: 1 A Randomized Double-Blinded Controlled Study
Background: The preventing effects of remifentanil and magnesium sulfate on hemodynamic responses to tracheal intubation were evaluated in a double-blinded controlled trial on pregnant women undergoing cesarean section delivery.
Methods: A total of 54 American Society of Anesthesiologists Class I-II women candidate for cesarean section delivery were randomly assigned to one of three groups (n = 18) to receive one of the following premedication: Intravenous (IV) remifentanil 0.75 µg/kg, IV magnesium sulfate 30 mg/kg, or IV normal saline 10 cc as placebo. All hemodynamic profiles were recorded immediately before and after intubation, and 2, 3, 5 minutes after tracheal intubation.
Results: Heart rate and systolic and diastolic blood pressures were significantly lower in the remifentanil group than in other groups both before and immediately after intubation. The trend of the changes in homodynamic responses within 5 minutes following intubation in the magnesium sulfate and placebo group was similar, but this trend in the remifentanil group was significant difference. In the same time, 1st and 5th minute Apgar scores were slightly lower in the remifentanil group than others. The measured parameters of umbilical cord blood pH and PO had no significant differences between the groups.
Conclusions: Remifentanil can attenuate hemodynamic response to tracheal intubation more effectively than magnesium sulfate, and thus it can be considered safe for a pregnant candidate for cesarean section.
Background: Cervical spondylotic myelopathy (CSM) is the result of prolonged compression of the central spinal canal. Clinical and radiological manifestations of CSM could be misleading and physicians need to be vigilant while evaluating patients with neurologic complaints otherwise delay in diagnosis and management would happen that could finally lead to a poor outcome. The aim of this study was to report our series of patients with CSM to reiterate that CSM could have diverse manifestations, and it can be only identified if the physicians are aware and do a thorough investigation. The progressive nature of CSM makes its early diagnosis and subsequent appropriate management vital to avoid further complications.
Methods: A total of 10 patients who had diagnosed with CSM and undergone surgical treatment at our institute evaluated according to the pre-operative and post-operative Nurrick classification and also pre-operative history and physical examination findings and elecrodiagnostic examination.
Conclusions: Because of progressive nature CSM and wide range of clinical manifestation, high index of suspicion, early diagnosis and early treatment prior to permanent spinal cord injury is recommended.
Background: Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s) are uncommon but well-known entities.
Case Report: The patient is a 60-year-old male with a history of dyspnea and surgical removal of kidney stonein 1 year ago.
Results: In chest-X-ray prior to the surgery an olive-shaped homogenous density, with a size of 30 mm × 20 mm in the right lung have been detected. Computed tomography (CT) scan has been performed, and a homogenous mass with a well-delineated border in major fissure of the right lung and mediastinal lymphadenopathy had been detected. Serial CT scans revealed mass enlargement. In Ct guided, Transthoracic biopsy fluid collection along the major fissure of the right lung had been detected. Biopsy of mediastinal lymph node silicoanthracotic changes with focal hyaline fibrosis had been shown.
Conclusions: The diagnosis of the phantom tumor must be considered in any patient with congestive heart failure and lung mass. In this patient, there was no history of congestive heart failure which shows that phantom tumor could happen in non-chronic heart failure patients. Although the accurate diagnosis of the phantom tumor with imaging modalities in patients without congestive heart failure is very difficult but at least this diagnosis must be considered in a patient with a lung mass in the major fissure of the lungs.