Vol 4 No 1 (2017)
Photorefractive Keratectomy for Mild-to-Moderate Myopics with Thin Corneas: A 3-Year Follow-up Results
Background: The purpose of this study was to evaluate the 3-year visual outcomes in mild-to-moderate myopic patients with thin corneas who underwent photorefractive keratectomy (PRK) with or without mitomycin C (MMC).
Methods: Thirty myopic eyes with a mean spherical equivalent (SE) of −3.76 ± 1.72 (−6.50 to −1.25) diopter (D) and a mean corneal thickness of 486.03 ± 11.93 (452-499) µm at the thinnest point underwent PRK. MMC was used if they had > 4.0 D myopia. All surgeries were performed with the VISX STAR S4 Excimer Laser (Abbott Medical Optics, Abbott Park, Illinois, USA).
Results: Uncorrected visual acuity showed a significant improvement 3 years after surgery when compared to baseline and reached 0.01 ± 0.04 LogMAR (P < 0.001). Best-corrected visual acuity was 0.00 ± 0.01 LogMAR preoperatively and did not change significantly postoperatively. Spherical (P < 0.001) and cylindrical (P < 0.001) error significantly decreased. Manifest refraction SE showed a significant decrease when compared to before the operation and reached −0.08 ± 0.16 D (P < 0.001). At 3 years, mesopic contrast sensitivity was not significantly different from baseline at any spatial frequency. Vertical coma showed a significant decrease and reached −0.10 ± 0.27 µm (P = 0.004). Total coma (P < 0.001), spherical aberration (P < 0.001), and total high order aberrations (P < 0.001) also increased significantly.
Conclusions: Based on the 3-year results, PRK (+MMC in patients with SE > 4.0 D) is a safe, effective, and predictable treatment option for mild-to-moderate myopic patients whose minimum corneal thickness is < 500 µm.
Evaluation of the Effect of Intravenous Ondansetron versus Placebo before Anesthesia on Vomiting after Endoscopy and Colonoscopy Procedures
Background: Vomiting is a common complication after endoscopic procedures in children. Different medications could be administered to control vomiting after endoscopy. The goal of this study is to evaluate anti-emetic effects of ondansetron in children who undergo endoscopic procedures.
Methods: In this clinical randomized trial, 198 children (103 female/95 male) were randomly assigned into one of the following two studied groups. Case group (G1): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + ondansetron 0.15 mg/kg and control group (G2): Fentanyl 1 µg/kg + propofol 2.5 mg/kg + 2 cc normal saline.
Results: The mean age was 6.3 ± 3.5 years (6.2 ± 3.6 years in G1 vs. 6.4 ± 3.5 years in G2). The most common cause of endoscopy procedure in both groups was hematochezia. Vomiting, recovery time, Paediatric Anesthesia Emergence Delirium (PAED), and Aldrete scores were compared. Rate of vomiting after recovery and Aldrete score were significantly different between the two groups.
Conclusions:Ondansetron is effective in controlling vomiting after colonoscopy and upper gastrointestinal endoscopic procedures. Also, patients in intervention group experienced better recovery time.
Background: Arteriovenous (AV) fistula is the first choice of a long-term vascular access for hemodialysis, but there is a 20-30% probability of thrombosis in the 1st month after its creation. Ticlopidine is a potent drug, which inhibits both primary and secondary platelet aggregation. This study is performed to evaluate the effect of ticlopidine in the prevention of AV fistula.
Methods: Totally 124 patients in need of an AV fistula were divided into two groups after creation of their fistula. In the first group, we prescribed ticlopidine for 62 patients, and in the second group, 62 patients received placebo. The two groups were compared to see if their fistulas are patent or thrombotic after 1 and 3 months.
Results: Of the 62 patients who received ticlopidine, four had fistula thrombosis, while in 62 patients who received placebo, 16 had fistula thrombosis (P = 0.003). This shows the significant effect of ticlopidine in the prevention of thrombosis in AV fistulas. Also, we compared age, sex, and the fistula location in the ticlopidine and placebo groups, and these attributes had no significant difference between the two groups (P > 0.050).
Conclusions: Considering the significant value of ticlopidine in the prevention of AV fistula thrombosis, it can be recommended after the surgery if there is no contraindication for its use.
Background: Coronary artery disease (CAD) and cancer have common risk factors. According to the necessity of mass resection in patients with CAD at the same time, we decided to do neck and head mass resection and coronary artery bypass grafting (CABG) simultaneously and assess the results.
Methods: The current study was done on patients who were candidates for simultaneous head and neck mass resection and CABG. The patients’ files were extracted, the information and complications were recorded in a questionnaire, and then necessary data were extracted.
Results: Totally 9 patients (3 females and 6 males) with a mean age of 69.11 ± 6.67 standard deviation years were studied. The most common site of squamous cell carcinoma in this study was tongue. Infection occurred in three patients, two of which (66.66%) died. Side effects occurred in four patients.
Conclusions: It seems that, according to the anatomical position of neck mass, proximity to the airways and large blood supply in that area, and also because of inappropriate access to the anatomical zones, the survival rate and complications in this surgical setting (simultaneous surgeries) are different from that of other studies. It seems that further studies are needed to be done with the subject of concomitant head and neck mass surgery and CABG this time with a larger number of patients.
Relationship between Phosphatase and Tensin Gene Expression and Clinicopathologic Features of Breast Cancer in Patients who Underwent Biopsy or Breast Surgery
Background: Phosphatase and tensin (PTEN) gene is a tumor suppressor gene on chromosome 10q23 that is composed of 11 exons. Several studies have shown that loss of PTEN function is a common occurrence in breast cancer in particular in triple negative type, and it is significantly associated with age and higher stage of cancer. In this study, the expression of this gene in malignant breast cancer tissue samples and their correlation with clinicopathologic parameters was studied.
Methods: In this retrospective study, 65 malignant tissue samples were chosen for immunohistochemistry (IHC) test. Other information about clinicopathologic features were collected from pathology reports and patients’ medical records. IHC on the selected paraffin blocks was performed, and the collected data were analyzed using SPSS software and chi-square test. P < 0.0500 was considered statistically significant.
Results: PTEN expression rate in malignant breast tissue was 50.8% of the cases (33 out of 65 samples). Lack of PTEN expression had significant correlation with involvement of the lymph node sent by the sample, vascular or perineural invasion, metastasis and chemotherapy background, spontaneous malignancy presence, familial history, negative progesterone receptor, negative estrogen receptor, and positive her2/neu. No relationship was observed between the expression of PTEN with patients’ age, tumor size, age group of the patients after categorization into two groups of under 50 years and over 50 years, lesion location (left or right breast), and tumor grade.
Conclusions: The results showed PTEN loss as a frequent event in breast cancer that is closely associated with progression and poor prognosis. PTEN loss might predict more aggressive behavior and worse outcomes in patients with breast cancer.
Effect of Intravenous Paracetamol on Acute Post-operative Pain, Nausea, and Vomiting after Outpatient Diagnostic Laparoscopy for Infertility
Background: Post-operative pain, nausea, and vomiting (PONV) are significant causes of morbidity among patients undergoing outpatient diagnostic laparoscopy. However, the optimal strategy for prevention of these side effects remains unclear. Many drugs and their combination have been used to attenuate these adverse responses. We conducted a study to evaluate the effect of intravenous (IV) paracetamol on attenuation of acute post-operative pain and opioid consumption and as a result PONV at the same time in infertile women undergoing diagnostic laparoscopy.
Methods: A total of 104 American Society of Anesthesiologists Class I-II infertile women aged 18-40 years, who were scheduled for elective diagnostic laparoscopy under general anesthesia, were included and anesthetized with the same technique. The paracetamol group received IV infusion of 1000 mg paracetamol in 100 ml saline, and the placebo group received the same volume of saline after induction of anesthesia. Pain score at the end of surgery and 1 hour later, PONV and fentanyl consumption as rescue analgesic at the recovery room were all recorded and compared between the two groups.
Results: There were no significant differences between the two groups regarding demographic data. Mean pain score was 2.8 ± 2.7 in paracetamol group and 4.3 ± 3.5 in placebo group at the end of surgery (P = 0.016). Mean pain score was 3.7 ± 2.1 in paracetamol group and 4.6 ± 2.2 in placebo group 1 hour after surgery (P = 0.030). Nearly 36% of patients in placebo group and 14% in paracetamol group need additional fentanyl for pain relief after surgery (P = 0.008). Incidence of post-operative nausea was 16.3% and 14.5% in placebo and paracetamol groups, respectively, (P = 0.150). Incidence of post-operative vomiting was 6% and 0 in placebo and paracetamol groups, respectively, (P = 0.040).
Conclusions: IV paracetamol reduced post-operative pain and nausea in infertile women undergoing diagnostic laparoscopy for assisted reproductive techniques.
Background: Müllerian duct cyst is an uncommon congenital anomaly. It is usually small and asymptomatic. A rare case of this entity with symptoms of ejaculatory duct obstruction such as hematospermia and secondary infertility is presented here.
Case Report: A 39-year-old male presented with complaints of pain in the lower abdomen, dysuria, frequency, and hematospermia for the last 2 years. He also suffered from secondary infertility with a 9-year-old son. Imaging studies showed a large cystic midline lesion right behind the bladder and also bilateral dilated ejaculatory ducts. The patient underwent a transurethral drainage. The prostatic urethra was resected using a 26 Fr resection loop proximal to the verumontanum and a capacious cystic structure opened, and finally two dilated ejaculatory duct openings were seen. On follow-up, a significant improvement of symptoms and semen quality was achieved after surgery.
Conclusions: A high index of suspicion in using advanced imaging modalities is necessary for the diagnosis of this anomaly. Surgical excision of a Müllerian duct cyst may be performed depending on the size and location of the cyst and the presence of clinical symptoms. Transurethral de-roofing of the cyst is effective and safe for the treatment of small Müllerian duct cyst accompanied with ejaculatory duct obstruction.