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Introduction: Basal cell carcinoma is the most common malignancy in humans. A number of treatment modalities are available. We performed this study in order to determine the efficacy of Mohs micrographic surgery in treatment of basal cell carcinoma.
Materials and Methods: This retrospective descriptive study was performed on 194 basal cell carcinoma (in 175 patients) were treated in Isfahan Al-Zahra Hospital from september 1999 to March 2003 with Mohs micrographic surgery. Data were obtained from patient's files and were analized by SPSS software.
Results: Of the 175 patients (with 194 basal cell carcinomas), 110 (62.85%) paticnls were male and 65 patients (37.14%) were females. The mean age of patients was 58±12.38 years. The majority of tumors were located on face and scalp. 180 of tumors were primary and 14 were recurrences. 17% of tumors were larger than 2cm. Recurrences of the tumor occured in 3 patients. The cosmetic results were excellent and good in 81%. The incidence of recurrnce rate was 0.9%.
Conclusion: Kecurrence rate is low when basal cell carcinomas treated with micrographic surgery so this treatment modality (when indicated) is also strongly recommended in Iran for the treatment of basal cell carcinoma.

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Introduction: Postoperative hypothermia is physiologically stressful by elevating blood pressure, heart rate and plasma catecholamine concentration. This study conducted to evaluate the effects of intravenous fluids temperature on perioperative hemodynamic situation. Materials and Methods: This was a randomized clinical trial study Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in 60 volunteer patients undergoing orthopedic surgeries subjects randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using and dry IV fluid warmer. Results: The core and skin temperature of hypothermia and normothermia group decreased significantly from induction of anesthesia toward end of surgery but its reduction was more in hypothermia group (P<0.005). Postoperative mean arterial blood pressure increased significantly more in hypothermia group versus normothermia group (P<0.005). Shivering was observed in 21 of 30 hypothermia and 11 of 30 normothermia group (p<0.005) and recovery time was significantly lower in normothermia group (36±5 vs. 26±3 min, P<0.005). Conclusion: Infusion of warm fluids helps to reduce the variation of postoperative mean arterial blood pressure, core and skin temperature, occurrence of shivering and recovery time.

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Introduction: Cystic hygroma is a disorder in lymphatic vessel formation that involves the adjacent organs and can affect them due to its fast growing nature . The main treatment for cystic hygroma is surgical intervention that can have many complications after surgery. Treatments other than surgical interventions is the use of sclerosing agents. The goal of this study is to analyze the effect of Beliomycin in treating cystic hygroma . Materials and Methods: This quasi experimental study was carried out clinically at st-al Zahra and Kashanie hospitals of Isfahan from 1372 to 1383. A checklist including age, sex, cyst location, cystic hygroma volume before and after Beliomycin injection and/or surgery, was completed for each patient. Data was analyzed by T and paired T-Tests. p<0.05 was considered meaningful. Results:The study was carried out on 72 patients. 24 patients were treated with Beliomycin and 48 patient by surgery. Patients age was below 1 month up to 18 years old . Cystic hygroma was mainly located at neck region(46.8%). The average size of cystic hygroma was 103.9±29.66cm3 before Beliomycin injection and 34.91 16.19cm3 after that (p=0.004). and 43.511±7.81cm3 before surgery and 1.39±1.39 cm3 after that(p=0.006). The rate of recurrence of lymphingoma in the surgery treated group was 25.1% and in the group treated with Beliomycin was 29.2% with no significant difference. Conclusion: Regarding the considerable decrease in cyst volume after Beliomycin injection and it,s low complication compared to surgery, this method can be used as a primary treatment or supplementary to surgery.

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Introduction: Renal cell carcinoma can be presented with extension of thrombosis to renal vein and inferior vena cava. Management of these patients consists of radical nephrectomy and thrombectomy. In this study we reviewed approach to these patients. Materials & Methods: This is a case series report. During 1379 to 1384, 148 patients diagnosed with renal cell carcinoma (RCC) limited to Gerota’s fascia (stage T3 or less) were admitted to Hasheminejad hospital. Fourteen patients had inferior vena cava (IVC) involvement. Radical nephrectomy as well as thrombectomy was performed in 8 patients. This investigation is done on these 8 patients. Results: Patients' average age was 51.4 years. Six patients were male (75%) and 2 female (25%). The most common symptoms were flank pain (75%), gross hematuria (62.5%) and structural symptoms (50%). All patients had tumors limited to Gerota’s fascia without any distant metastasis. Infrahepatic involvement of IVC was seen in 6 patients and in 2 patients thrombosis extended above the hepatic vein (infrahepatic). No perioperative mortality was seen. Postoperative complications were atelectasia in 2 patients and deep vein thrombosis in one which was treated with conservative management. Conclusion:By skillful surgical approach in patients with RCC and IVC involvement, thrombosis can be completely excised without increasing the rate of complications and longterm survival could be expected.

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Introduction: Using one subcutaneous infiltration of Bopivacaine can cause a good pain relief in pediatric surgery, so the child may no longer need rectal Acetaminophen after surgery. In this study, we compared the efficacy of the two drugs. Materials and Methods: This was a clinical trial, performed on 141 pediatric patients between 6 months to 3 years old with unilateral or bilateral inguinal hernia or undescending testis. Patients were divided randomly into two groups. The first group received infiltration of Bopivacaine preoperatively and the second received the routine rectal Acetaminophen after surgery. In both groups pain score was measured with FPRS score 3,6,12 and 24 hours after surgery. After collecting data they were analyzed with T-student and Friedman tests. P<0/05 was considered significant. Results: Global FPRS pain score was lower in the group treated with Bupivacaine infiltration on 3 and 6 hours after surgery (p<0/05), but in 12 and 24 hours after surgery no significant difference was seen in the two groups. Conclusion: This study showed that, infiltration of Bupivacaine reduces pain better than Acetaminophen, especially during the first 6 hours after surgery. So because of better pain control and also single administration, we suggest using infiltralition of Bupivacaine preoperatively.

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Introduction: Despite different methods implemented, surgical wound infection is still an important cause of mortality and morbidity of patients which impose a considerable cost on health care system. According to recent data, administration of supplemental oxygen during operation can reduce the risk of wound infection due to increased tissue oxygenation and therefore better elimination of bacteria by oxidative killing. This study is done to investigate the effect of administered oxygen ratio on the incidence of wound infection in clean-contaminated surgery. Materials and Methods: This is a double blind clinical trial. 584 patients from both sexes between 18 to 60 years old, who were condidated for clean-contaminated surgery were divided into two equal groups randomly. One recived 80% and the other 40% FIO2 during anesthesia. The frequency of wound infection between the two groups was assessed during a two weeks period. Results: Of patients receiving 80% FIO2, 11 (3.9%) patients, and the group recieving 40% FIO2, 25(8.1%) patients had wound infection (p<0.05). Conclusion: This study similar to previous studies showed the positive effect of supplemental oxygen in decreasing risk of surgical wound infection. Therefore according to the low risk and low cost and effectivness of this method in patients undergone surgery, it is recommended in clean-contaminated surgery.

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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: Fungal spores are present in large amounts in the nature which may cause diseases in the susceptible individuals. Fungal rhinosinusitis has been increased during recent decades. This study aims to investigate fungal rhinosinusitis in the patients with chronic needing endoscopic sinus surgery aims and to determine the sensitivity of the isolates to rhin sinusitis antifungal agents.

Materials and Methods: In cross sectional study, specimens were obtained in sterile plates containing normal saline. from the suspected cases of chronic rhinosinusitis who had undergone endoscopic sinus surgery. Microscopic experiments and Cultures were done in Sabouraud Dextrose Agar medium. Minimum inhibitory concentration (MIC) of the growth of fungi for seven antifungal agents against the isolates was determined using E-Test.

Results: In total, specimens from 102 immunocompetent patients were examined. Nine positive specimens were presented, consisting of 3 for Aspergillus fumigatus, 3 for Penicillium, 2 for Aspergillus flavus and 1 for Alternaria. The mean age of the patients was 38 years, with 59 males and 43 females. The isolates were most sensitive to the voriconazole and amphotericin B.

Conclusion: Since the prevalence of fungal rhinosinusitis is low, unfortunately, the clinicians are not attentive enough to the condition, and they initiate antifungal therapy if the patients are not responsive to antibiotics. Early diagnosis and suitable treatment can help more efficient management of patients.

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Abstract

Background: Bariatric surgery is the most effective intervention for treating severe obesity and patient's adherence to self-management behaviors is essential to reduce complications after surgery. The purpose of this study was to investigate the psychometric properties of BSSQ in Iranian population.

Materials and Methods: The statistical society was all of the obese patients that underwent laparoscopic obesity surgery in Shiraz Ghadir Mother & Child Hospital from December 2016 till June 2016, and 201 of them (149 females and 52 males) were selected by using available sampling method. They responded to demographic characteristics, post bariatric surgery self-management behaviors questionnaire and general and specific adherence scales. For validity, methods such as content validity, structural validity (factor analysis and correlation analysis), simultaneous validity were used. The reliability of the questionnaire was determined by using bisection and internal stability methods by Cronbach s alpha.

Results: According to the results of explatory factor analysis, sisx factors including eating behaviors, physical activity, fruits, vegitables, grain and protein intake, fluid intake and dumping syndrome management were elicited, that these 6 factors explained 61.54% of variance of self-management behaviors. Total score of correlation matrix BSSQ with GAS & SAS were 0.363 and 0.702. For reliability, the Cronbach's alpha coefficient of this instrument was found 0.90 and guttman split-half coefficient was 0.78.

Conclusion: Results show that BSSQ has an acceptable validity and reliability and it can be used for assessing the post bariatric surgery self-management behaviors in Iranian population.

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Introduction: The present study was conducted to investigate the effectiveness of schema therapy on marital satisfaction and mental health of women undergoing hysterectomy surgery.
Methods: This research was applied in terms of objective and quantitative research, and in terms of data collection method, it was semi-experimental research with two experimental and control groups with pre-test and post-test. The statistical population consisted of all women aged 30 to 50 who underwent hysterectomy surgery in 2023 in Yazd city. In this study,
30 eligible subjects were selected by the available method, and the participants were randomly divided into two experimental and control groups (15 people in each group). For the experimental group, the treatment plan was implemented in 10 sessions of 50 minutes. Goldberg's mental health questionnaire and Inrich's marital satisfaction questionnaire were used to measure the research variables.
Results: The findings from the analysis of the covariance test showed the use of the schema therapy approach increased the marital satisfaction and mental health of women undergoing hysterectomy surgery (p ≤ 0.001).
Conclusions: Therefore, the use of schema therapy sessions in medical centers for people who underwent hysterectomy surgery is suggested to reduce marital problems.