Vol 3 No 1-2 (2016)
Background: The purpose of this study was to determine the consumption of blood products during orthognathic surgeries by age, sex, blood group, operation time, and the amount of blood loss.
Methods: This is a retrospective cohort study. Patients who underwent bimaxillary osteotomy were studied. The study focused on types and amount of blood loss, blood products used, and change in patient’s hemoglobin (Hb) and hematocrit (HCT). Patients’ demographic data, blood type, and duration of surgery were variables of the research.
Results: A total of 133 patients (52 males and 81 females) with a mean age of 22.950 ± 4.241 years formed the study population. Average blood loss was 556.32 ± 245.05 ml and the average operating time was 259.96 ± 51.56 minutes. Results demonstrated that duration of the surgical and blood loss in males was higher than females. The mean of Hb and HCT levels before surgeries was 13.56 ± 1.30 and 40.47 ± 4.30, respectively, which significantly (P < 0.001) decreased to 11.969 ± 1.200 and 35.782 ± 3.800 1 day after the operations. The transfused blood products consisted of packed cells (5.4%), fresh frozen plasma (37.3%), and hydroxyethyl starch (57.3%). The percentage of patients who did not receive any transfusion was generally higher in the positive blood types than negative ones, with the highest percentage being in the AB+ group.
Conclusions: A risk of using blood products particularly packed cells may increase if blood loss was above of 800 ml and surgical duration more than 300 minutes. The duration of orthognathic surgery may have a significant effect on blood loss and blood transfusions. It seems subjects with positive blood types may have a lower risk for transfusion.
The Effect of Intravenous Infusion of Magnesium Sulfate During Bimaxillary Orthognathic Surgery on Post-operative Pain: A Clinical Trial
Background: This prospective randomized controlled clinical study aimed to investigate the effect of magnesium sulfate (MgSO4) on pain management post orthognathic surgery.
Methods: In this study, 52 patients undergoing orthognatic surgery were randomly allocated to receive MgSO4 or saline intravenously. The intervention group (n = 26) received intravenous MgSO4 (30 mg/kg bolus for 15 minutes immediately before anesthesia induction followed by 10 mg/kg/h dissolved in saline via pump infusion) and the second group (n = 26) received the placebo in the same bolus volume as a normal saline in a 15 minute intravenous infusion which was continued until the end of the operation. A visual analog scale (VAS) was used to determine the intensity of pain. Invasive arterial blood pressure and valid and invalid analgesic demand were also recorded. Side effects were recorded, as well.
Results: This study was conducted on 52 patients, 26 per group. The results showed no statistically significant differences between the two groups with respect to demographics. During the post-operative period, the patients in the control group showed larger analgesic requirement 7 (26.9%) compared to those in the magnesium group 4 (15.4%) and the difference was not statistically significant (P = 0.308). The post-operative VAS scores evaluated serially from the recovery room also showed a significant difference between the intervention 3 (11.5%) and the control group 14 (53.8%) after the surgery (P = 0.001). However, no significant difference was found between the two groups regarding VAS scores in the surgical ward [7 (26.9%) vs. 8 (30.8%) P = 0.760].
Conclusions: Intra-operative administration of intravenous MgSO4 reduced opioid consumption for pain after bimaxillary orthognathic operations.
Simultaneous Helicobacter Pylori Infection in Gastric Mucosa and Gallbladder Mucosa in Patients with Cholecystitis; Is There Any Relationship?
Background: This study aimed to assess the prevalence of Helicobacter pylori infection in gastric and gallbladder in patients with acute cholecystitis or symptomatic cholelitiasis undergoing cholecystectomy.
Methods: 43 patients with biliary disease (cholecystitis or cholelitiasis) with inclusion criteria were selected in Shahid Modarres Hospital, Tehran, Iran. The data including age, sex, and the presence of Helicobacter pylori in biopsy samples of gallbladder and gastric mucosa for each patient were recorded and analyzed using SPSS software.
Results: The biopsy specimens of gastric and gallbladder mucosa of 43 patients with the mean age of 54.8 ± 9.9 years were studied. 22 (51.2%) patients had acute cholecystitis and 21 (48.8%) had cholelithiasis. Among the gastric samples, 14 patients (32.6%) (9 men and 5 women) and in the gallbladder samples, 19 patients (44.2%) (8 women and 11 men) were positive for Helicobacter pylori. The simultaneous presence of Helicobacter pylori in the gastric and gallbladder mucosa was seen in 6 patients (13.9%). 10 patients (23.2%) were smokers, and 33 (76.7%) were non-smokers.
Conclusions: It can be said that the presence of Helicobacter pylori in gallbladder can play an important role in the creation and spread of the infection. But the simultaneous presence of Helicobacter pylori infection in gastric and gallbladder cannot be a good standard to evaluate the diseases of the bile ducts.
Background: In regard to the rarity of pediatric tendon lacerations compared with the adult population, sparse knowledge exists. Published reports indicate that the incidence of “good” flexor tendon repair outcomes is low. This study aimed to determine the injury pattern and demographics of pediatric flexor tendon injuries over the past decade.
Methods: A retrospective chart review of all flexor tendon injuries between 2005 and 2015 was performed. Parameters reviewed included demographics, injury mechanism, repair technique, outcomes, and complications.
Results: A total of 20 patients with a median age of 4 years and 4 months experienced 45 tendon injuries. The most common cause of injury was glass (n = 10), with the most common digit injured being the index finger (n = 8). Zone II had the highest number of injuries (n = 14). The modified Kessler core and peripheral running sutures technique were used in all primary repairs (n = 18). Using author designed evaluation system, 80% of patients experienced excellent recovery. Four patients had good results. Only one patient complicated with rupture necessitating further surgery that its final evaluation was excellent.
Conclusions: The outcome of restoring flexor tendon injury of children is satisfactory, and we recommend that.
Effect of Magnesium Sulfate on Hemodynamic Changes During Sternotomy and Laryngoscopy in Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial
Background: This study was designed to evaluate the effectiveness of low and high dose magnesium sulfate in reducing pressure responses to laryngoscopy and sternotomy.
Methods: A total of 90 patients were assigned into three groups. The patients in Group L received a 20 mg/kg bolus dose of magnesium sulfate 3 minutes before intubation followed by an infusion of magnesium sulfate (10 mg/kg/h) in contrast to 40 mg/kg of magnesium sulfate followed by an infusion of 20 mg/kg/h magnesium sulfate administered to Group H. Patients in Group P received saline as placebo. Heart rate and mean arterial pressure (MAP) recorded at the baseline were noted down again before intubation and 30 seconds, 2 and 4 minutes after intubation and 1 minute before, and 30 seconds, 2 and 4 minutes after sternotomy.
Results: MAP in Groups L and H compared to Group P was significantly lower, after intubation (P = 0.0040). The difference between MAP in Groups L and H was only statistically significant 30 seconds after intubation. MAP 30 seconds and 2 minutes after sternotomy was statistically different between Groups L and H compared to Group P. The difference between Groups H and P was only statistically significant before sternotomy and 4 minutes after sternotomy (P = 0.0001).
Conclusions: A low dose magnesium sulfate attenuates the hemodynamic response to laryngoscopy and sternotomy in coronary artery bypass graft surgery.
Background: A sentinel lymph node (SLN) biopsy is an interesting issue in the field of surgical oncology and has recently been introduced to the treatment of gastric cancer. The purpose of this study is to assess accuracy, sensitivity, specificity, and false negative rates (FNRs) of SLN biopsies, and to ascertain whether or not this procedure is useful for locally advanced gastric cancer.
Methods: From December 2013 to March 2014, 22 patients with gastric cancer were enrolled in this study. After laparotomy, patent blue was injected around the tumor subserosaly, resection was then done, and SLNs were detected on a back table. Afterward, D2 dissection was carried out. Finally, SLNs and other specimens were submitted for permanent pathology.
Results: SLNs were detected in 20 of 22 patients. The total number of SLNs was 87. SLNs were positive in 7 patients, and the total number of positive SLNs was 17. In three patients, the SLNs were negative, whereas other LNs were positive, with an FNR of 15%. 18 patients received neoadjuvant. Complete pathologic responses with negative LNs were seen in 3 patients. Accuracy, sensitivity, specificity, and negative predictive values were 80%, 66%, 90%, and 76%, respectively.
Conclusions: This research demonstrated that SLN mapping in advanced gastric cancer is an appropriate method with acceptable levels of accuracy, sensitivity, and negative predictive values, even in those patients who received neoadjuvant treatment.
Asymptomatic Giant Left Atrium: Do Atrial Size Changes After Successful Valve Replacement? 7-Years Follow-up Case Report
Background: Giant left atrium (GLA) associated with mitral valve surgery reported to have a mortality ranging from 8% to 32%. Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. Either we must do or not do a reduction arterioplasty at the time of the mitral valve surgery is a controversy in the literature.
Case Report: The patient had mitral valve replacement with a with a 31 mm carbomedics mechanical valve prosthesis 7 years past during her last visit. No reduction arterioplasty was done with a valve operation. Her 7-years close follow-up was uneventful. In the last visit, echocardiography and spiral chest computerized tomography scanning were requested. In both of the requested images giant left trial enlargement was seen, but the patient was without symptoms regarding her giant left atrium.
Conclusions: In this case report, it seems that if we want left atrial size decline, it is necessary to have reduction arterioplasty during mitral valve surgery. However, it does not mean a definite therapeutic efficacy, especially when considering future symptoms.
Background: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm originating from soft tissue. It was initially described as a distinctive clinical entity by Christopherson et al. in 1952. The peak age of incidence is between 15 and 35 years with slight sex predominance among women. The most common sites involved include extremities and trunk and in young adults and head and neck in children. ASPS is a slow-growing tumor with unusual patterns of metastasis which runs a poor prognosis. The aim of this article was to present a case of ASPS of retroperitoneal origin along with its diagnostic and therapeutic workups.
Case Report: A 31-year-old patients with a chief complain of an abdominal mass in right lower quadrant, underwent surgical resection as a neuroendocrine tumor according to pre-operative imaging studies. Pathology reported the lesion as ASPS. The patient refused adjuvant chemotherapy and unfortunately he did not show up to continue his treatment and further follow-ups. A careful investigation would be required including clinical findings, clinicopathological correlation, with appropriate radiological studies, before definitive treatment of ASPS.
Conclusions: The main problem to gain an extended insight into clinical features and optimal treatment is the rarity of the disease. Given the ineffectiveness of current treatments in advanced ASPS, further future investigation to find new therapeutic options would be required.