Vol 4 No 2 (2017)
Background: Hydatid cyst communicated with biliary tract increases the morbidity and mortality rates. Therefore, early detection and treatment are vital.
Methods: From 96 patients undergone hydatid cyst surgery, 12 were excluded. The specifications, size, location, and position of the cyst, the condition of the cyst wall thickness, the caught lobe, cyst rupture, liver abscess, and the size of the inside and outside liver bile ducts were identified through computed tomography scanning. Age, gender, icterus, white blood cell (WBC) count, the total, direct, and indirect bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase were identified.
Results: In 21 patients (13 men and 8 women), there was communication between the hydatid cyst and biliary tract; from them, 14 patients had icterus. There were significant differences between the size of the cyst, the levels of liver enzymes, bilirubin, and alkaline phosphatase, and WBC count in communicated and non-communicated hydatid cysts (P = 0.001). There were no significant differences between the two groups in terms of age, gender, location of the cysts in the liver, and the thickness of the liver.
Conclusions: Only the cyst size and the level of bilirubin were the predicting factor for the communication between hydatid cyst and biliary tract.
Biological Optimization of Cortical Bone Allografts: A Study on the Effects of Mesenchymal Stem Cells and Partial Demineralization and Laser Perforation
Background: Despite promising results have shown by osteogenic cell-based demineralized bone matrix composites, they need to be optimized for grafts that act as structural frameworks in load-bearing defects. The purpose of this experiment is to determine the effect of bone marrow mesenchymal stem cells seeding on partially demineralized laser-perforated (DLP) structural allografts that have been implanted in critical femoral defects.
Methods: Thirty-two Wistar rats were divided into four groups according to the type of structural bone allograft; the first: partially demineralized only (Donly), the second: partially demineralized stem cell seeded (DST), the third: partially DLP, and the fourth: partially demineralized laser-perforated and stem cell seeded (DLPST). Trans-cortical holes were achieved in four rows of three holes approximated cylindrical holes 0.5 mm in diameter, with centers 2.5 mm apart. P3 mesenchymal stromal cells (MSCs) were used for graft seeding. Histologic and histomorphometric analysis was performed at 12 weeks.
Results: DLP grafts had the highest woven bone formation, where most parts of laser pores were completely healed by woven bone. DST and DLPST grafts surfaces had extra vessel-ingrowth-like porosities. Furthermore, in the DLPST grafts, a distinct bone formation at the interfaces was noted.
Conclusions:This study indicated that surface changes induced by laser perforation, accelerated angiogenesis induction by MSCs, which resulted in endochondral bone formation at the interface. Despite non-optimal results, stem cells showed a tendency to improve osteochondrogenesis, and the process might have improved if they could have been supplemented with the proper stipulations.
Comparing the Effect of Eutectic Mixture of Lidocaine and Prilocaine and Capsaicin on Improving Ischemic Random Skin Flaps: An Animal Model
Background: Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.
Methods: A number of 39 white-albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.
Results: The mean values of necrosis in the flaps were 603.33 ± 116.00 mm2, 665.00 ± 220.26 mm2, and 920.00 ± 247.31 mm2 in the EMLA, capsaicin and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).
Conclusions: EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.
Background: Breast cancer is the most common disease of women around the world. On the other hand, benign breast diseases also constitute a wide range of breast pathologies that precise information on them is important. This study is conducted aiming to examine the breast pathology reports and determine the frequency of various breast diseases and its relationship with some clinicopathologic parameters in Imam Reza Hospital of army of the Islamic Republic of Iran in a period of 4 years.
Methods: Imam Reza Hospital is a referral center for Army employees in Iran. This study is a retrospective descriptive study on patients who undertook biopsy or breast surgery during 2012-2015 in Imam Reza Hospital. After reviewing pathology reports and patient records and completing the required information, a total of 188 patients with 230 samples of breast tissue were included in this study.
Results: During the period, 230 samples of breast tissue from 188 patients were sent to the pathology department. 195 samples (84.8%) were related to female patients and 35 samples (15.2%) to males.
112 samples (48.7%) were related to the left breast and 118 samples to the right (51.3%). The average size of tissues was 11.82 ± 8.64 cm. The mean age of patients was 42 ± 14.
Conclusions: In this study, a statistically significant relationship exists between the patient sex and final diagnosis, patient age group and final diagnosis, and cell differentiation grade and lymph node metastasis along with samples. In the pathology reports in the center, cell differentiation grade of tumor was completely matched with Nottingham Grading System.
Background: Spinal tumors account for 10-15% of total central nervous system neoplasms. This study presents the results of surgical procedures performed on a significant number of patients with spinal tumors.
Methods: The present article presents results of surgery performed on 104 of 204 patients with spinal cord tumors referred to the hospital clinic where they underwent the operation from 2005 to 2015. The studied cases included age, sex, and duration of the disease, and clinical symptoms and their time of occurrence, place of birth, radiological characteristics, surgical results, surgical resection, tumor histology, and complications. In addition, the results are compared with other studies.
Results: A total of 104 studied subjects who underwent the surgery 50% were male. The mean age of patients was 37.1 years. The most common site of the tumor was the thoracic (30.8%) and cervical regions (27.9%). Extramedullary and intramedullary tumors accounted for 74.1% and 25.7% of cases, respectively. Among the extramedullary masses, the most common pathology was nerve plexus tumor (58.4%) and then meningium (18.2%). Astrocytoma (55.6%) and epandiomy (25.9%) were, respectively, the most common types of intramedullary tumors. The total or almost total resection was performed in 78.9 of cases. The average follow-up time was 29 months. The post-operative neurological status of patients was improved in 84.6% of cases.
Conclusions: The factors affecting on the final state of the patients after the operation include the degree of malignancy, the extent of the lesion and the pre-operative severity of the neural defect.
The Effect of Informing Parents or Caregivers of Patients on Their Anxiety from Anesthesia Risks during Their Child’s Surgery
Background: Each patient who needs a surgical operation is going under general anesthesia with many risks. The purpose of this investigation was to determine whether the provision of detailed anesthetic risk information is associated with increased parental anxiety.
Methods: In this randomized clinical trial study 140 caregivers of patients admitted for surgery, was selected in order of their reference and they were asked to fulfill the test. In the next step, persons were distributed into two groups of the control group with an even number and the intervention group with odd number (according to the numbers on questionnaire). The routine information about the risks of anesthesia was given to the control group with an even number at the operation date in holding area, and they were asked to re-fulfill the questionnaire.
Results: The majority of parents (> 95%) preferred to have comprehensive information concerning their child’s perioperative period, including information about all possible complications. For selected items, increased parental educational level was associated with increased desire for information (P < 0.050). For Phase 2, when the intervention group was compared with the control group, there were no significant differences in parental anxiety over the 4 time points [F(1,45) = 0.6, P = 0.410]. Furthermore, the interaction between time and group assignment was not significant [F(3,135) = 1.66, P = 0.181].
Conclusions: We conclude that parents of children undergoing surgery desire comprehensive perioperative information. Moreover, when provided with highly detailed anesthetic risk information, the parental anxiety level did not increase.
Giant Solitary Fibrous Tumor of the Liver, Case Report: Unusual Site, Extravagant Presentation, Aggressive Behavior
Background: Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal tumor. It can originate from abdominal soft tissue which is extremely scarce, and liver indeed is super scant site. SFT liver (SFTL) is mostly benign, but it can be malignant and aggressive with metastases and a potential of recurrence. Hypoglycemia is the least reported feature which is resistant to medical management and will be resolved following resection of a SFT of liver.
Case Report: A 67-year-old man presented with episodes of sudden onset loss of consciousness since 3 months before first visit. He was a previously healthy farmer, without any other complaint or past medical history except for episodes of sever hypoglycemia. Laboratory testing revealed hypoglycemia which was temporarily response to glucose infusion, hypoglycemia was refractive, and whole physical examination and laboratory tests were done and there were no abnormal findings. With probability of finding something such as insulinoma or any other tumor that secreted insulin or insulin-like growth factors, a magnetic resonance imaging (MRI) was performed and revealed an enhancing giant round and well-defined lesion in left lobe of live.
Conclusions: We here present the first case of malignant SFTL presenting with hypoglycemia and metastasis to soft tissue as inguinal bulging 2 months after resection of liver mass, but this particular type of tumor needs more evaluation and investigation.
Background: Placenta percreta is a rare complication of pregnancy with catastrophic outcomes for both mother and fetus. Abnormal placental attachment due to inadequate deciduas formation between trophoblast and myometrium is the main histological finding.
Case Report: We present a case of placenta percreta in a 25-year-old woman accompanied by spontaneous uterine rupture at 25th week of gestation. In view of clinical symptoms and laboratory findings, the patient underwent laparotomy with a primary diagnosis of acute abdomen. We found no predisposing factor for abnormal placentation. As our patient wished to remain fertile, a successful uterine repair was performed.
Conclusions: Histological assessment of the uterus showed placenta percreta. It is very rare for placenta percreta to cause uterine rupture in the second trimester, especially in a patient without any risk factors.