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Background: Acute pancreatitis is a common cause of abdominal pain, without any characteristic signs, symptoms, or a gold standard diagnostic modality. The purpose of this study was to evaluate the diagnostic value of urine trypsinogen-2 strip test in acute pancreatitis. Materials and Methods: In this cross-sectional study, 76 patients with abdominal pain suspected to acute pancreatitis who were admitted to the Emergency ward of Valiasr Hospital, Arak, were evaluated. In 46 patients, acute pancreatitis was confirmed (pancreatitis group), whereas in 28 patients, acute pancreatitis was ruled out (control group). In both groups serum levels of amylase, lipase, CRP, and urine trypsinogen-2 were measured by quantitative and qualitative methods. Sensitivity and specificity of the tests were determined and data were analyzed using SPSS software. Results: Urine trypsinogen-2 dipstick was positive in 36 of the 45 patients in the pancreatitis group (sensitivity: 80%) and in 2 of the 28 patients in the control group (specificity: 92.8%). Urine trypsinogen-2 ELISA test was positive in 41 of the 45 patients in the pancreatitis group (sensitivity: 91.1%) and in 4 of the 28 patients in the control group (specificity: 89%). Amylase sensitivity and specificity were equal to 82.6% and 75%, respectively. Lipase sensitivity and specificity were 76% and 85.7%, respectively. Conclusion: Urine trypsinogen-2 dipstick can be used to differentiate acute pancreatitis from other causes of abdominal pain. This rapid, easy-to-use, and accurate test can be used in emergency wards and primary health care units with limited diagnostic facilities.

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Background: Several studies have demonstrated that the levels of inflammatory markers in healthy women are under the influence of menstrual cycle changes. The aim of this study was to compare blood levels of inflammatory markers in women with appendicitis in different phases of menstrual cycle. Materials and Methods: In this case-control study, 70 female and 12 male patients with appendicitis, and 61 healthy women were enrolled based on inclusion and exclusion criteria. Inflammatory markers, such as leukocyte count, CRP, ESR, and TNF-α were measured and compared using student t-test and one-way ANOVA based on different phases of menstrual cycle. Results: There were no significant changes in the ESR, CRP, and TNF-α concentrations and the number of peripheral blood leukocytes in different phases of the menstrual cycle in women with appendicitis. The mean number of leukocytes and CRP concentrations were significantly higher in patients with appendicitis compared with the control group. Conclusion: The findings show that there are not significant differences in the inflammatory markers in women with appendicitis during the different phases of menstrual cycles. It seems that day to day variation of sexual hormones in the menstrual cycle have led to very different conclusions about the change of inflammatory markers in different phases of menstrual cycle. Therefore, studies investigating inflammatory markers in women with acute appendicitis based on day of menstrual cycle, time of sampling in the day, and severity of appendicitis are suggested.

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Background: Cataract is the leading cause of blindness and visual impairment. This study was performed to compare effects of two different incision types in cataract surgery on dry eye symptoms and diagnostic test values. Materials and Methods: In this clinical trial, 300 patients with cataract requiring phacoemulsification were studied. The patients were randomly divided into two operative method groups: limbal and clear corneal (anterior to the vascular arcade) incision. A complete set of ophthalmic examinations and tear related tests were done for all of the patients before surgery and one week and one month after surgery. The collected data were analyzed using SPSS and EPI-Info softwares. Results: Overall, 149 men and 151 women were enrolled in this study. On the first postoperative week, the means of symptoms, and TBUT and TMH values in both groups significantly decreased compared with the preoperative values. These values returned to the preoperative levels one month postoperatively which werein contrast to the changes of debri, PEE, corneal and conjnnctival staining. There were statistically significant differences between the results of pre- and post-operative symptoms, PEE, debri, TBUT, conjunctival and corneal staining. Except for TBUT, the results of these tests were not statistically different according to incision location. Conclusion: Phacoemulsification cataract surgery affects dry eye symptoms and diagnostic test values. In addition, except for TBUT, the location of incision had no effect on other test results and symptoms.

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Background: Central venous catheterization (CVC) is a common procedure associated with various side effects such as pneumothorax. Recently, the routine post-catheterization chest X-ray has been challenged. The aim of the present study was to design a scoring system for selecting patients requiring radiography after CVC procedure. Materials and Methods: In this cross-sectional study, 210 patients requiring CVC were enrolled in the study and pneumothorax potential risk factors, including body mass index>30, history of neck or chest surgery, emphysematous disease, history of catheterization, number of punctures, inappropriate position during CVC, and treatment with ventilator were recorded. Finally, chest radiography and clinical signs before and after CVC were compared and scoring system sensitivity and specificity were determined. Results: Incidence of pneumothorax was 5.24%. The number of punctures and patient's position and history of catheterization showed significant associations with pneumothorax development (p<0.001). Pneumothorax incidence in patients with score> 4 was 80% which was significantly higher than patients with score<4 (OR: 174.2, p<0.001). Sensitivity and specificity of using the scoring system at cut-off score> 2 were 81.8% and 87.9%, respectively. Conclusion: The results of this study showed that pneumothorax development risk is very low in patients with score<2 and there is no need for post CVC routine chest X-ray. However, in patients with score>4, pneumothorax development risk is high and it seems that chest radiography with close intervals even more than one time is necessary. Further studies are recommended to validate the proposed scoring system.

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Background: For calculating intraocular lens (IOL) power required for cataract surgery, ultrasonic biometry is used and the axial length of the eye is the most important error in this estimation. Therefore, the aim of this study is to evaluate the final refractive power based on the axis length of the eye in patients undergoing phacoemulsification cataract surgery.

Materials and Methods: In this cross-sectional study, from June 2010 till December 2011, 446 eyes which underwent phacoemulsification cataract surgery were investigated. Biometry was performed before cataract surgery to achieve emmetropia in all eyes. Based on the axis length of the eye, patients were classified into four groups: less than 22 mm, 22-24.5 mm, 24.5-26 mm, and more than 26 mm.

Results: There was not a significant difference in mean absolute value of final refractive power deviation from zero. The highest amount of mean absolute value of final refractive power deviation from zero was in myopia group which was equal to 1.52±1.17 diopter. However, there was not a significant difference in the amounts of mean absolute value of final refractive power deviation from zero according to axial length of the eye (p=0.081).

Conclusion: With increases in axial length of the eye, intraocular lens power calculation decreases, but the absolute difference of means is not significant in two apparatuses.

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Background: Endophthalmitis is the most important complication after cataract surgery which its incidence can lead to severe loss of vision or even loss of vision therefore, methods of prevention are very important. This study investigated the influence of vancomycin consumption during cataract surgery on prevention of endophthalmitis.

Materials and Methods: In this experimental study, the study population included patients of cataract surgery that were admitted to Amir Kabir Hospital. The patients were randomly assigned to two groups: with and without receiveing vancomycin in serum. Demographic characteristics of the patients before surgery and incidence of endophthalmitis with the examination until two weeks after surgery were recorded. To compare the frequency (incidence) of infection, endophthalmitis in two groups, Fisher's exact test and X2 test were used.

Results: Of the 1281 patients, 539 were administered vancomycin in serum. The examination after two weeks indicated that 3 (0.23%) patients developed endophthalmitis. Of these, 2 (0.16%) patients belonged to the group without vancomycin and 1(0.07%) patient belonged to the group receiving vancomycin. Fisher's exact test did not show any significant differences between the groups receiving vancomycin and the control group in the prevalence of endophthalmitis.

Conclusion: Although the relative frequency of endophthalmitis in patients without receiving vancomycin was further than control group, the difference was not statistically significant. Thus, adding a drop of vancomycine was not effective in prevention of endophthalmitis and the causes should be sought in other cases.

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Background: Hydatid disease is a common infection caused by Echinococcus granulosus. Cerebral involvement is very rare and only occurs in 2% of all hydatidosis in endemic areas. We report a case of primary multiple cerebral hydatid cysts in a 23 years old patient. Case: A 23 years old female was admitted in our emergency ward with primary generalized tonic colonic seizure, left body and face hemiparesis and history of headache in last two months. Contrast enhanced CT and MRI showed a big well-defined, rounded, cystic lesion in the motor strip of right temporo-parietal region with mass effect causing midline shift which was diagnostic for brain hydatid cyst and several smaller cysts. There was no evidence of other organs involvement. The patient underwent the brain surgery. A big hydatid cyst (10cm in diameter) and some others adhering to brain parenchyma in different sizes were evacuated completely and without rupture using Dowling method. Patient received albendazole 400mg/two times a day for 2 months too. There was no cyst in patient’s MRI study in two years follow up.

Conclusion: Though low incidence, primary multiple cerebral hydatid cysts should be considered in endemic area using brain CT and MRI. Surgery is standard treatment of the disease.

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Background: Monitoring of facial nerve function during surgery help surgeons to preserve the nerve during parotid gland surgery. EMG is currently the standard method for monitoring, however, the rates of facial nerve paresis and paralyses are 68-18% and 3%, respectively. The disadvantages of this method are its cost and lack of access to it everywhere. Unipolar alternating electric current stimulation of the facial nerve causes contraction of the muscles and the nerves, and the damage can be avoided.

Materials and Methods: In this study, patients in the years 1388 to 1390 using monopolar electrocautery was undergoing parotidectomy and one month after surgery, the facial nerve injury were examined. During the study period, twenty patients had undergone total or superficial parotid gland resection and one excluded due to facial nerve involvement before surgery.

Results: In this study, 19 patients were studied. The mean age of patients participating in this study, 43.1 ± 13.9 years and 63.2% of them (12 cases) were female. A temporary palsy (5.4%) was observed and there was no paralysis.

Conclusion: Due to its availability and low cost, using electrocautery devices compared with standard facial nerve monitoring, EMG, is beneficial and the treatment results are also satisfactory.

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Background: Thymus is essential in creating some of the disorders and diseases. Treatment of these disorders (particularly tumors and myasthenia gravis) is possible with complete removal of the thymus.

Materials and Methods: In this retrospective study over a period of eleven years, all case of thymectomy performed at the Department of Thoracic Surgery of shahid Beheshti University has investigated. Variables examined included age, sex, primary diagnosis, surgical technique, complications and results of surgery.

Results: The total number of patients was 50 (46% male and 54% female) with a mean age of 85.14 ± 46.41 years. Primary diagnosis was myasthenia gravis in 40% of patients and thymoma in 42% of them. Myasthenic symptom was the most common presenting symptom (50%). Radical thymectomy surgery was performed in 64% of patients. Fever and atelectasis (10%) and respiratory failure (12%) were the most common postoperative complication and mortality rate was 4%. Thymoma (64%) and thymus hyperplasia (20%) were the most frequent pathology. Clinical symptoms were gone or greatly reduced in 40% of patients. The majority of them had a primary diagnosis of myasthenia gravis (36%). 50% of patients have been followed up. The mean follow-up time in these patients is 32.20 ± 36.41 months.

Conclusion: Thymectomy surgery with low morbidity and mortality, provides the possibility of treatment of thymic lesions. Especially Thymoma and Myasthenia Gravis

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Background: Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Man is an intermediate or accidental host of this parasite, and is infested by consuming contaminated plants or vegetables, or by contact with dogs. The larvae travel through the gut wall and 60-75% are filtered by the liver, and a few travel directly to the lungs to produce a hydatid cyst there. Growth of hydatid cysts has been reported in the spleen, muscles, bones, and brain. Hydatid cyst embolism to peripheral limb arteries is extremely rare.

Case: A 41-year-old gravided woman presented with sudden pain, erythema and warming of the olden infra-inguinal mass which existed from 1 year ago. The notable findings at physical examination included 40*20 mm diameter soft mass with warming and erythema in 4 cm below inguinal ligament of right lower limb. She didn’t mentioned any previous history hydatid cyst. Intraoperatively, Percutaneous aspiration of the mass was performed which demonstrate white turbid fluid. after the surgical incision we saw the white colored subcutaneous hydatid cyst and completely remove it and send it to pathological examination which confirmed hydatid cyst diagnosis. further liver ultrasound and chest radiography hasn’t shown any evidence of liver or lung involvement.

Conclusion: Cystic echinococcosis may affect all organs, but mostly settles in the liver and lungs. We do not have data on the means by which the larvae of echinococcosis reach the inguinal area without liver and lung involvement. Considering the anatomy of the groin and its lymphatic tissue, we can make an assumption about how the hydatid cysts settle in the groin space. Although it occurs rarely, larvae in the gastrointestinal tract may pass to the lymphatic circulation, and then settle in the groin space through the rich lymphatic flow of inguinal area.

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Background: Peripheral nerve injures are common in clinical practice that includes from compression injury to complete disruption of nerve trunk. After injury nerves can grow and repair spontaneously, early end to end anastomosis is first choice for repair but only 50% of nerve fiber would be physiologically accurate and effective, thus several techniques for repair of nerve injury are introduced including combination of nerve transplant with silicon tubes, use of biologic and synthetic tubes for nerve conduit.

Materials and Methods: In this Exprimental study, 20 rats with the same weight were selected and kept in the same condition .The left sciatic nerve of them was cut and were divided in two groups.In the first group the facial flap method for repair of nerve injury was used .In the second group vein conduit method was used as standard method. Histological nerve repair was assessed after 45 days and the intact right sciatic nerve was used as control.

Results: Repair of nerve injury in proximal, mid and distal portion of nerve in facial flap method was more effective than vein conduit (P<0.05). Repair of nerve injury in proximal, mid and distal portion had no difference compared with control group (p>0.05).

Conclusion: Repair of nerve injury with facial flap method is more effective than standard method and can be used as a new method for nerve repair.

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Background: Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular choice for dialysis. In the absence of a suitable vein in the wrist, elbow brachiocephalic fistula is the next choice. In this study to create an arteriovenous fistula in antecubital area, we turned to the proximal radial artery in comparison to brachial artery in antecobital area for dialysis.

Materials and Methods: We reviewed 124patients in clinical trial study that candidated for placement of AVF for dialysis in antecubital area .To create AVF ,proximal radial artery in 62 patients and brachial artery in 62 other patients selected as the artery of choice,then patients followed based on complications ,steal syndrome ,primary failure and mean time to prepare for dialysis.

Results: The mean time of maturation of AVF in brachial group was 41 days and in radial group was 43 days. Primary dysfunction in brachial group was 6 cases (10%) and in radial group was 5 cases (8%). Steal syndrome in radial group was not seen but in brachial group 2 cases (3%) were seen.

Conclusion: According to the primary success, steal syndrome and mean time of maturation of these two arteries had no significant statistic differences, but like other previous studies, this study emphasizes on usefulness and less complications. On the other hand, due to the anterior anatomical position and allowing the release of the artery, it causes easy technique for creating AVF anastomosis to the antecubital arteries and its branches.. Therefore, this study recommends use of this artery in creation of AVF in antecubital area.

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Background: Glaucoma is the second most common cause of blindness and it is one of the main causes of irreversible blindness. Multi-drug regimens usually recommended in reducing intraocular pressure (IOP) in patients with glaucoma. This study was aimed to compare the effect of combination therapy with Timolol and Latanoprost vs. Timolol and Dorzolamide in reducing IOP in patients with open-angle glaucoma.

Materials and Methods: In this blind randomized clinical trial study, 60 eyes with glaucoma were randomly assigned to two treatment groups including Timolol and Latanoprost vs. Timolol and Dorzolamide. Required variables were measured before and 6 weeks after the intervention. The data was analyzed by running the Stata software (version 12) at a significance level of 0.05.

Results: The mean age in groups of Timolol-Latanoprost and Timolol and Dorzolamide was 72.6 and 67.6 years old, respectively. Analysis of the data revealed that there was no significant difference between groups in terms of intraocular pressure (IOP), visual acuity and cup to disc ratio.

Conclusion: According to our findings, there were no statistical significant differences in the IOP lowering effect between both treatments in open angle glaucoma patients.

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Background: Catamenial recurrent pneumothorax is spontaneous pneumothorax in women of reproductive age, which includes 1-30% of spontaneous pneumothoraces in women and is associated with the menstrual cycle.

 Case: A 39-year-old woman with sudden onset dyspnea, respiratory distress and decreased right side respiratory sounds with a history of spontaneous pneumothorax and chest tube placement one month ago. The patient's symptoms improved after chest tube placement and within less than 24 hours after onset, she began menstruating. Treatment was performed with chemical pleurodesis with tetracycline and oral danazol.

Conclusion: Catamenial pneumothorax and thoracic endometriosis should be considered in all women of childbearing age with spontaneous recurrent pneumothorax. Early detection of this syndrome can result in reduction of morbidity and mortality with recurrence episodes.

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Background: Allergic rhinitis is a common disease which is present in 20% of general population. Major symptoms include sneezing, rhinorrhea, nasal congestion, and nasal pruritus. It seems that tricyclic antidepressants blocking histamine receptors may be used as an effective treatment in allergic rhinitis.

Materials and Methods: In this clinical trial study, 84 patients with allergic rhinitis entered the study and randomly divided into two groups. Patients of 1st group received cetirizine and 2nd group received doxepin for 2 weeks. After 2 weeks patients were evaluated about sneezing, rhinorrhea, nasal congestion, and nasal pruritus.

Results: The results of our study showed that clinical score of patients after 2 weeks was not different in both groups (p=0.261). The only symptom that was affected by the kind of treatment and was significantly different between groups was sneezing (p=0.005).

Conclusion: It seems that there is not much difference in using cetirizine and doxepin in treatment of seasonal allergic rhinitis sympotoms. It is recommended that future studies use TCAs with more potent blocking anti-histamine receptors feature and on more samples.

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Background: Despite advances in surgical techniques and risk management practices in recent years, wound dehiscence following abdominal laparotomy has still high prevalence. The purpose of this study is to evaluate the effect of retention sutures on wound dehiscence of emergent abdominal laparotomy.

Materials and Methods: In this randomized clinical trial study, 160 patients scheduled for emergency laparotomy for peritonitis or trauma were enrolled. Half of the patients randomly underwent retention suture and the other half underwent routine sutures. Finally, the amount of surgical wound dehiscence and complications were assessed. 

Results: Three patients (3.7%) in retention group and 11 patients (13.7%) in the control group developed wound dehiscence which there was a significant difference between them (p=0.025). It was determined by multivariate logistic regression that wound dehiscence is correlated with hemodynamic status, type of trauma and injury to the abdominal organs, and sex. The incidence of wound dehiscence, early hemodynamic instability, penetrating abdominal trauma and damage to the intestines were higher in males. 

Conclusion: In general, it seems that the preventive use of retention sutures in patients with multiple risk factors for postoperative wound dehiscence can be useful.

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Background: Myelomeningocele is one of the common congenital malformation in childhood that has association with many disorders. in addition to routine management of associated disorders surgical repair of myelomeningocele has been considered in many cases . The aim of this study is to evaluate the role of myelomeningocele surgical repair in prognosis of children with myelomeningocele

Materials and Methods: This is a case-control study from 2001 to 2013 in 60 infants with myelomeningocele in two department of neurosurgery in Arak and Ilam cities (Vali Asr and Imam Khomeni hospitals, respectively). Infants were divided into two groups according to operable and inoperable cases (each group includes 30 cases). The prognosis of two groups was investigated with respect to mortality, and Stark and Drummond disability rating scale. Data were analyzed with SPSS 18 software.

Results: Case group had better prognoses compared to control with respect to handicap (p=0.003), urinary tract disorders (p=0.006), IQ (p=0.001), global disability(p=0.006) and mortality rate, but there was no difference between two groups with respect to hydrocephalus(p=0.3).

Conclusion: According to the results, mortality, disability and prognosis of infants with myelomeningocele that underwent operation were better. In conclusion, early myelomeningocele repair is advised for infants, because it affects the improvement of prognosis and the quality of patients' life.

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Background: This essay reports a case about tissue defect of heel due to melanoma excision.

Patient history: The patient was a man 60 years old with a heel ulcer that had reported malignant melanoma in biopsy. Then the ulcer was done under wide local excision.

Materials and Methods: We should use flap for tissue defect coverage that tendon and heel bone are exposed from it. It seems using skin graft is not useful, because skin graft in persistent contact with shoes will get chronic ulcer. Among different flaps (sural flap or medial plantar flap), we decided to use medial plantar flap. The advantage of this flap is its sensority and low volume.

Conclusion: Conclusion with due attention the results, The meial planter flap, as an efficient method, is adviced to teconstruct heed specially after excision of melanoma.

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Background: The definite treatment of indicated Hypertrophy of the tonsils is Tonsillectomy. The aim of this study was to compare the efficacy and necessity of diclofenac suppository and simultaneous prescription of acetaminophen alone in controlling and reducing pain and improving swallowing and satisfaction after surgery for tonsillectomy in children.

Materials and Methods: In this clinical trial, 180 children 7 to 14 years Tvnsykltvmy surgery were enrolled. Patients in an improbable way, easy and were divided into three groups of 60. Immediately after the surgery acetaminophen, diclofenac, or a combination of both was used. The cases of pain in the early hours, seventh, thirteenth and nineteenth after surgery were compared.

Results: There was a significant difference between the average pains of all groups in all hours (p<0.05). There was a significant difference between the groups from the point of view of side effects such as Nausea, Vomiting and Pyrexia (p<0.05), But there was no significant difference between the groups from the point of view of After Surgery Bleeding (p>0.05).

Conclusion: We can say that Rectal Diclofenac is a more effective medication for reducing pain after the Tonsillectomy surgery in contrast with Rectal Acetaminophen or a mixture of the two, which may cause the patients to use less Narcotics after the surgery.

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Abstract

Introduction: Echinococcosis or hydatid cyst disease is one of the most common infectious diseases between animals and humans (zoonosis) that is endemic in all the countries of the Mediterranean region, including Iran. Pelvic involvement is rare, and the involvement of the uterus is very rare.

Case Report: 26-year-old female patient complained of limb paresis, ataxia and progressive headaches diagnosed with hydatid cyst of the brain was undergone surgery. The pain and slight swelling in the area of the wrist occurred, one year later and with the same diagnosis, surgery was performed again. Abdominal ultrasound showed two cystic lesions in the suprapubic region with a diagnosis of hydatid cyst of the uterus, 3 years later, surgery was performed. In all cases, the diagnosis was confirmed by pathology.

Discussion: Follow-up of patients with radiologic and serologic methods is necessary.

Conclusion: In patients with any clinical manifestation of endemic areas, particularly if there is a previous history of hydatidosis, hydatid cyst should be considered in terms of risk.