Vol 3 No 3-4 (2016)
Background: In the past decades, a significant increase has been observed in head and face traumas bleeding during and after surgery is one of the most important and dangerous factors for patients. This study was performed to assess the bleeding amount in patients during maxillofacial surgeries and the necessity of blood transfusion.
Methods: In this cross-sectional study, 441 patients were enrolled, of which 83.2% and 16.8% were male and female, respectively. To compare the patients’ mean hemoglobin concentration before and after surgery, paired t-test was used. Furthermore, to compare the mean hemoglobin concentration and mean intraoperative bleeding between males and females, independent t-test was used. The significance level was set as 0.05 for all tests.
Results: Results showed that the mean difference of hemoglobin concentration before and after surgery in patients of the study had a significant difference (P < 0.001). The amount of blood loss during surgery showed no significant difference between males and females (P > 0.050).
Conclusions: The results of this study demonstrated that there was a decrease in mean hemoglobin concentration after surgery, and also, the amount of blood loss in patients during surgery was not high enough for blood transfusion. However, it should be considered that to prevent any problem during surgery, assessing patients with anemia before surgical operations is necessary.
The Effect of Different Combination Doses of Intrathecal Hyperbaric Bupivacaine 0.5% and Sufentanil on the Hemodynamic Profile of Geriatric Patients Undergoing Hip Surgery under Spinal Anesthesia
Background: With the increasing number of elderly patients with fragile hemodynamic profiles undergoing lower limb surgery, avoiding hypotension in this population is of great importance. We intended to study the effect of different combination doses of intrathecal hyperbaric bupivacaine 0.5% and sufentanil on the hemodynamic profile of geriatric patients undergoing lower limb surgery.
Methods: A total of 60 patients aged over 70, candidates for lower limb surgery under spinal anesthesia were enrolled in this study. The patients were randomly allocated into three groups. Group 1 (G1: 5 mg bupivacaine plus 10 µg sufentanil intrathecally), Group 2 (G2: 10 mg bupivacaine plus 5 µg sufentanil intrathecally), and Group 3 (G3: 15 mg bupivacaine intrathecally). Non-invasive automated blood pressure was checked every 1 minute for the first 5 minutes, and every 5 minutes for 25 minutes and every 15 minutes for 30 minutes during surgery. Heart rate (HR) was recorded at the same intervals. The quality of the blocks was also compared.
Results: A total of 60 patients met the inclusion criteria and were enrolled in the study. Five patients had failed spinal anesthesia whom were replaced with new patients. There was no difference between the groups in their baseline characteristics. Mean arterial pressure after 1 minute in Groups 2 and 3 was significantly lower than Group 1 (86.0 ± 9.0, 87.3 ± 11.0, 92.2 ± 13.0, P = 0.001). No statistically significant difference in HR was observed in between the three groups. The degree of motor and sensory block was adequate in all three groups, and no patients required any additional analgesics. 15 (75%) patients in Group 3 received ephedrine in comparison to 11 (55%) patients in Group 2. 3 (15%) patients in group one needed ephedrine.
Conclusions: In conclusion, adding sufentanil as an adjuvant and decreasing the dose of intrathecal hyperbaric bupivacaine may help maintain a stable hemodynamic during lower limb surgery in the elderly.
Tension-free Primary Closure, Secondary Intention, and Limberg Flap, Which Is More Effective in Treatment of Uncomplicated Pilonidal Sinus Disease?
Background: This study was performed to compare the efficacy and long-term outcomes of three surgical treatments for uncomplicated pilonidal sinus disease, tension-free primary closure, Limberg flap, and secondary intention (wide excision and packing).
Methods: In this randomized clinical trial study, 66 patients with uncomplicated pilonidal sinus disease were randomly assigned to be surgically treated using tension-free primary closure, Limberg flap, or secondary intention methods. The outcomes including pain, healing time, recurrence, complications, disability, reoperation, and patient satisfaction were compared between three groups after two years of follow-up.
Findings: In Limberg flap group, the healing time and disability were significantly less than the two other groups; besides, the pain was significantly less than secondary intention group and more than the primary closure group (P < 0.0001 for all). There were no significant differences between the groups regarding recurrence, complications, reoperation, and patient satisfaction (P > 0.05 for all).
Conclusions: Totally, according to our findings and comparison with other studies, it may be concluded that Limberg flap is relatively better than primary and secondary intention in patients with uncomplicated pilonidal sinus disease.
Background: Nephron sparing surgery (NSS) for unilateral Wilms tumor (WT) has been debated recently and is being used to preserve kidney tissue and function. However, NSS is feasible only for selected cases with higher local relapse rates. There is a significant reduction of nephrons with the development of renal hypertension and progressive renal failure. In this paper, we have analyzed outcomes after bilateral partial nephrectomy (PN) and unilateral partial plus contralateral total nephrectomy in our patients with bilateral WT.
Methods: We have analyzed our four patients (8 kidneys) with bilateral WT and 8 unilateral complete resection. Kidney size was measured using volumetric analysis computed tomography scan imaging. The patients were matched with children who had undergone imaging of the abdomen for other malignancies.
Results: Mean kidney volumes after unilateral partial plus total contralateral nephrectomy (60.9 cm3) were significantly greater than the reference kidneys. Total kidney volume was significantly larger after bilateral PN (98.1 cm3) versus unilateral partial plus total contralateral nephrectomy (60.9 cm3).
Conclusions: Our findings suggest that patients with bilateral WT benefit from bilateral NSS. Hypertension is less common after bilateral PN. However, rates of local relapse or disease associated death are separately between the groups.
Background: Post-operative transient hypocalcemia is a common event after total thyroidectomy. It may reveal permanent hypoparathyroidism following total or subtotal thyroidectomy. It has been hypothesized that there is a relationship between underlying vitamin D deficiency and the risk of post-operative hypocalcemia.
Methods: We performed a cross-sectional review on 100 thyroidectomies from 2016 at an academic teaching hospital. Pre-operative vitamin D levels and post-operative calcium level were obtained. The incidence of hypocalcemic symptoms was studied. Biochemical hypocalcemia was defined as any single post-operative corrected calcium level < 8.0 mg/dl (to convert to millimoles per liter, multiply by 0.25).
Results: Post-operative calcemia < 8.0 mg/dl was observed in 19 patients (19%). We found that the patients carried a high risk for post-operative transient biochemical hypocalcemia if the pre-operative serum vitamin D levels ˂ 35 nmol/L. There was a significant differentiation between mean of vitamin D levels in hypocalcemic group and normocalcemic group.
Conclusions: Pre-operative vitamin D levels appear to have a significant effect on the risk of post-thyroidectomy hypocalcemia.
Background: Numerous treatments strategies were used for Meniere disease (MD). In this study, we aimed to compare the efficacy of intratympanic dexamethasone versus intratympanic placebo in intractable MD.
Methods: This was a single-blinded randomized clinical trial. All patients with Intractable MD underwent ventilation tube insertion into tympanic membrane and were randomly allocated to two groups of 18-patients. The patients of the first group used dexamethasone base drop (placebo) every other day, the second group used dexamethasone drop for 3 months, and all patients were followed for 12 months.
Results: Control of vertigo and tinnitus with dexamethasone was more than the placebo, but there was no statistically significance difference between two groups (P > 0.05). Hearing function improvement and aural fullness resolution were higher in the placebo group, but there was no statistically significance difference, too (P > 0.05). Vertigo control in dexamethasone group in our study ranged from 72.2% to 83.3% of patients at different intervals. These figures ranged from 66.6% to 83.3% in placebo group. The highest rate of hearing function improvement in our study was 27.7% in placebo group. Tinnitus also followed the same pattern as hearing function.
Conclusions: Intratympanic dexamethasone for MD is very satisfactory if medical treatment fails with good vertigo control and no risk to hearing.
Background: Synovial sarcomas commonly occur in the extremities of young adults. A primary occurrence in the mediastinum is very rare with only a few reported cases in the world literature.
Case Report: This paper is about a 47-year-old male who presented with retrosternal chest pain and shortness of breath on exertion. Imaging showed an anterior mediastinal mass. Pathological examination of the resected mass showed a biphasic neoplasm with a spindle cell component admixed with gland-like elements. The tumor showed positive staining with cytokeratin, epithelial membrane antigen, and vimentin confirming the diagnosis of a biphasic synovial sarcoma.
Conclusions: A wide range of neoplasms, both primary and metastatic, occurs in the mediastinum, which poses considerable diagnostic difficulties. A synovial sarcoma should always be considered in the differential diagnosis, and immunohistochemistry is an important adjuvant tool in this situation. This paper highlights the importance of recognizing an unusual presentation of this aggressive neoplasm to aid appropriate clinical management.