Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 2 3-4 2016 01 16 30 32 ENGLISH Razieh Nabi Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran Davood Jafari Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran Hooman Shariatzadeh Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran Farid Najdmazhar Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran Ali Ajvadi Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran 2016 01 16 2016 01 16 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/34 https://ajs.tums.ac.ir/index.php/ajs/article/download/34/25

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 2 3-4 2016 01 16 33 38 ENGLISH Nahid Hatam Department of Health Service Administration, School of Management and Medical Information Science, Shiraz University of Medical Sciences, Shiraz, Iran Mehrdad Askarian Department of Community Medicine, Shiraz Nephro–Urology Research Center, Shiraz University of Medical Sciences,Shiraz, Iran Fahime Khamzade Student Research Committee, School of Management and Medical Information Science, Shiraz University of Medical Sciences, Shiraz, Iran Peyman Jafari Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Peivand Bastani Department of Health Service Administration, School of Management and Medical Information Science, Shiraz University of Medical Sciences, Shiraz, Iran 2016 01 16 2016 01 16 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/35 https://ajs.tums.ac.ir/index.php/ajs/article/download/35/26

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 2 3-4 2016 01 16 39 44 ENGLISH Seyed Saeed Shirangi Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahdieh https://ajs.tums.ac.ir/index.php/ajs/article/view/5 https://ajs.tums.ac.ir/index.php/ajs/article/download/5/5

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 1 1-2 2015 10 05 11 14 EN Hamidreza Sharifnia Resident of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Kamran Shadvar Anesthesiologist, Tabriz University of Medical Sciences, Tabriz, Iran Omid Azimaraghi Resident of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Yasaman Aghajani Resident of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Maziar Molaghadimi Resident of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Maliheh Khosravi Resident of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Ali Movafegh Professor of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 05 2015 10 05 Background: Propofol is one of the drugs most commonly used during induction of anesthesia. The induction dose of propofol can lead to hemodynamic changes such as hypotension and bradycardia. Pain on injection is another side effect of propofol. The purpose of this study was to evaluate the effect of two different doses of ephedrine on hemodynamic status and pain on injection of propofol compared to lidocaine and placebo. Methods: In the present study, 100 patients were enrolled. A 22 gauge cannula was inserted into the veins on the non-dominant hand of all patients. The patients were randomly allocated to 4 groups and 10 ml/kg of saline was administered over 10 minutes from each of the cannulas. Then, patients received either of these pretreatments: 2 ml of Saline (group S); 2 ml lidocaine 2% (40 mg) (group L); Ephedrine (30 ug/kg) (group E1); or Ephedrine (70 ug/kg) (group E2). After 30 seconds all patients were administered 2.5 mg/kg of propofol with a rate of 1 ml per second. The patients were asked to give a score from 0 to 10 (0 = no pain and 10 = most severe pain) every 5 seconds until loss of consciousness. Systolic and diastolic pressures and heart rate were recorded before induction of anesthesia, before intubation, and 1, 3, and 5 minutes after intubation. Results: Systolic, diastolic, and mean arterial pressure and heart rate following induction in E1 and E2 groups were higher than S and L groups (P < 0.001). There were no differences in systolic, diastolic, and mean arterial pressure and heart rate 1, 3, and 5 minutes after intubation between groups. Lidocaine and both doses of ephedrine reduced pain on injection of propofol similarly. Conclusions: Lidocaine and high and low doses of ephedrine reduce the intensity of pain on injection of propofol. Small doses of ephedrine attenuate blood pressure and heart rate reduction after induction of anesthesia with propofol. https://ajs.tums.ac.ir/index.php/ajs/article/view/7 https://ajs.tums.ac.ir/index.php/ajs/article/download/7/7

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 1 1-2 2015 10 05 15 19 EN Seyed Mohammad Javad Mortazavi Associate Professor, Department of Orthopedic Surgery, Imam University Hospital AND Joint Reconstruction ResearchCenter, Tehran University of Medical Sciences, Tehran, Iran Sadegh Kalantar Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohsen Azadi Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Hasan Kaseb Associate Professor, Department of Orthopedic Surgery, Imam University Hospital, Tehran University of Medical Sciences,Tehran, Iran 2015 10 05 2015 10 05 Background: During the past decade, magnetic resonance imaging (MRI) has been accepted as the ideal approach for primary diagnosis of traumatic knee intra-articular lesion. Despite this, the overall diagnostic accuracy of MRI has been carefully scrutinized in Iran. The purpose of this investigation was to scrutinize the diagnostic accuracy of MRI of the knee in identifying traumatic intra-articular knee lesions. Methods: We compared MRI findings with subsequent arthroscopic findings (as the gold standard) in 107 patients (107 knees) with a clinical diagnosis of traumatic intra-articular knee lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of MRI were calculated based on arthroscopic findings for menisci and cruciate ligaments. Results: MRI showed the following results for medial meniscus: sensitivity 83%; specificity 37%; positive predictive value 46%; negative predictive value 77%; and accuracy 55%. For lateral meniscus it showed the following results: sensitivity 43%; specificity 86%; positive predictive value 40%; negative predictive value 87%; and accuracy 79%. MRI showed the following results for anterior cruciate ligament (ACL): sensitivity 62%; specificity 90%; positive predictive value 71%; negative predictive value 66%; and accuracy 75%. In addition, it showed the following results for posterior cruciate ligament (PCL): sensitivity 60%; specificity 94%; positive predictive value 42%; negative predictive value 98%; and accuracy 94%. The overall accuracy of MRI was 62.5%. We compared MRI accuracy in two time periods to investigate if there was any improvement over time. Our data showed a significant increase in the accuracy of detection of ACL injuries by MRI in more recent patients; however, there was no improvement in the diagnosis of other internal knee derangements. In addition, overall MRI accuracy was the same in patients from different age groups. Conclusions: We concluded that the overall accuracy of MRI in diagnosing intra-articular lesions of the knee in Iran is comparable with other published studies in the literature. However, it could be improved; if radiologists and orthopedists work together to find possible flaws, their cooperation would result in optimal use of this diagnostic modality. https://ajs.tums.ac.ir/index.php/ajs/article/view/3 https://ajs.tums.ac.ir/index.php/ajs/article/download/3/3

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 1 1-2 2015 10 05 20 24 EN Mohammad-Taghi Khorsandi-Ashtiani Professor of Otolaryngology, Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A’lam Hospital,Tehran University of Medical Sciences, Tehran, Iran Varasteh Vakili-Zarch Resident of Otolaryngology, Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A’lam Hospital,Tehran University of Medical Sciences, Tehran, Iran Ali Kouhi Assistant Professor of Otolaryngology, Otorhinolaryngology Research Center, Department of Otolaryngology, Amir-A’lamHospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 05 2015 10 05 Background: Stapes management in tympanosclerosis has always been controversial. There are evidences supporting stapes mobilization, but there are concerns regarding refixation and recurrence of conductive hearing loss; therefore, supporting stapedectomy. Methods: In this retrospective study, clinical records, operative notes, and audiologic data of patients with stapes fixation (1994–2011) were analyzed. Audiometric findings are reported according to the recommendations of the Committee on Hearing and Equilibrium 1995 Guidelines for the Evaluation of Results of Treatment of Conductive Hearing Loss. Results: In the present study, 66 patients were enrolled (23 male, 43 female). Stapedectomy and stapes mobilization both had good hearing results (12.1 dB vs. 10.6 dB reduction in ABG) and there was no significant difference. Overall, 63.6% of patients had achieved good results (mobilization: 57.9%, stapedectomy: 71.4%). The difference in success rate between the two groups was not statistically significant. Conclusions: Stapedectomy and mobilization of stapes both seem to be efficacious and safe in the treatment of stapes involvement in tympanosclerosis. The hearing improvement is long lasting in both procedures. https://ajs.tums.ac.ir/index.php/ajs/article/view/6 https://ajs.tums.ac.ir/index.php/ajs/article/download/6/6

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 1 1-2 2015 10 05 25 32 EN Zhamak Khorgami Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Saeed Shoar Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Nasrin Shoar School of Medicine, Kashan University of Medical Sciences, Kashan, Iran Delaram Shakoor Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Shirin Mahdavian Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Shirzad Nasiri Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Ahmadreza Soroush Department of Surgery AND Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital,Tehran University of Medical Sciences, Tehran, Iran Ali Aminian Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 05 2015 10 05 Despite huge advances in minimally invasive surgeries, efforts still continue for finding less invasive methods of surgery. Patients desire less postoperative pain as well as better cosmetic outcomes. This may be achieved by decreasing the number of laparoscopic ports in which all the surgical maneuvers are performed through a single incision. However, surgeons should be also equipped to act well while avoiding adverse events of the new practicing approach. Along with increasing trends in performing of single incision laparoscopic surgery (SILS) in routine practice, the number of assessing the pros and cons of this new modality is also on the rise. Although it has been claimed that SILS is able to make the dream of invisible laparoscopy true for patients and surgeons, consecutive studies regarding postoperative outcomes questioned the benefits of the new evolved technique. Subsequent meta-analysis also revealed equal outcomes for SILS in comparison to the standard laparoscopy. Our review aimed to outline the pros and cons of SILS. https://ajs.tums.ac.ir/index.php/ajs/article/view/2 https://ajs.tums.ac.ir/index.php/ajs/article/download/2/2

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 1 1-2 2015 10 05 33 37 EN Ali Ghorbani Department of Surgery, Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, TehranUniversity of Medical sciences, Tehran, Iran Hosein Mahmmodzadeh Department of Surgery, Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran Ahmad Tajedin Department of Surgery, Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran Ali Saadati Department of Surgery, Shariati Hospital, Tehran University of Medical sciences, Tehran, Iran 2015 10 05 2015 10 05 A 53-year-old man, who underwent total gastrectomy and esophagojejunostomy due to gastric cancer, came back to the emergency ward with delayed intra-abdominal haemorrhage. The patient was suffering from a distended, painful abdomenn. The patient was hypotensive, tachycardic, and oliguric. Laboratory analysis detected severe reduced haemoglobin concentration and coagulopathy. After resuscitation and correction of coagulopathy, the patient was transferred to the operating room. At the emergency operation we found that intra-abdominal haemorrhage was from the transverse mesocolon and site of celiac lymph node dissection. Haemostasis was done by suturing, cauterization, and patches with Surgicel. https://ajs.tums.ac.ir/index.php/ajs/article/view/8 https://ajs.tums.ac.ir/index.php/ajs/article/download/8/8

her 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/40 https://ajs.tums.ac.ir/index.php/ajs/article/download/40/30

Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 2 3-4 2016 01 16 66 69 ENGLISH Ali Ghorbani-Abdegah Department of Surgery, Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Reza Ershadi Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Amir Reza Radmard Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Keivan Gohari-Moghadam Department of Pulmonary Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Abbas Sadat-Safavi Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Ahmad Tajedin Department of Surgery, Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Alireza Bagheri Department of Pulmonology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2016 01 16 2016 01 16 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/41 https://ajs.tums.ac.ir/index.php/ajs/article/download/41/31