The effects of kiwifruit dressing on hypertrophic scars in a rabbit ear model.

AIMS: Hypertrophic scars show abnormal responses during healing. These scars, associated with dysregulated growth and excessive collagen formation, can have both functional and cosmetic consequences for patients. The present study evaluated the effects of kiwifruit on hypertrophic scars in a rabbit ear model. METHODS: This study included 13 New Zealand albino rabbits with full thickness wounds down to the cartilage (four wounds per ear; total: 104 scars). Sixteen days after initial wound formation, one ear of each rabbit was treated with daily kiwifruit dressing, while the other ear (control group) was dressed after normal saline irrigation for 10 days. Harvested skin samples were examined for histopathological, morphometric and immunohistochemical results. RESULTS: In comparison with the control group, early kiwifruit dressing significantly reduced the scar elevation index, fibroblast count and dermal collagen organisation. The ratio of collagen type III to total collagen immunoreactivity, inflammation and dermal capillary count increased significantly in the treated group, compared to the untreated controls. CONCLUSION: Based on the findings, early kiwifruit dressing improved the histological features of cutaneous wounds in rabbits. Therefore, this approach may be effective in clinical practice.

Thrombosis Prevention with Botulinum Toxin A after Traumatic Crush Injury in a Rat Model.

BACKGROUND: Revascularized digits may fail because of vessel thrombosis. The current study aimed to develop a standard model for crush injury in the rat femoral artery to evaluate the antithrombotic effect of perivascular botulinum toxin A (BTX-A) injection. METHODS: We explored bilateral femoral arteries of 10 rats using a microscopic technique. The crush injury was reproduced using a bulldog clamp. One randomly chosen leg of each rat was injected with BTX-A. The other side received normal saline as its own control. After 24 hours, the femoral arteries were ligated distal to the trauma site and were divided between the traumatized and ligated sites. RESULTS: All arteries injected with BTX-A had pulsatile bleeding without thrombosis. Arteries injected with normal saline had thrombosis without bleeding, except for one with oozing. The results showed the efficacy of BTX-A and its potential use in microvascular trauma (p < 0.001). CONCLUSION: The use of BTX-A preoperatively in the emergency department may help reduce traumatic stress and subsequent thrombosis and improve trauma management results. Complementary studies are needed to assess the ability of BTX-A to reduce thrombosis and vasospasm and improve survival of traumatized digits.

Surgical Treatment of Unicoronal Synostosis: A Simplified Technique without Orbital Osteotomy.

BACKGROUND: Although referrals for nonsyndromic frontal plagiocephaly have been increased during the past several years, successful surgical repair of unicoronal synostosis (UCS) remains a challenge for craniofacial surgeons. Most surgical techniques followed to correct supraorbital rim elevation and temporal constrictions are being noticed less and often require a secondary revision. But this new technique consists of correcting the affected ipsilateral frontal, temporal, and superior orbital rim areas in the first operation. METHODS: From 1995 to 2016, a total of 154 cases of UCS were operated by first author. A total of 91 patients were operated with standard technique, whereas the new technique was applied on 63. Whitaker scoring system was used for evaluation of patients after surgery. RESULTS: Data analysis shows a significant difference between 2 operation techniques results (P = 0.007). None of the patients from the new technique group required revision surgery. CONLUSIONS: We believe that our new technique have less invasive osteotomy on the frontal bone and no manipulation of the orbital bone, so provide sufficient bone graft and is applicable even for younger patients (<6 months).

Single-incision laparoscopic cholecystectomy using glove port in comparison with standard laparoscopic cholecystectomy SILC using glove port.

PURPOSE: Surgery with minimal scar has become a widely used surgical method during the last decade. Single-incision laparoscopic cholecystectomy (SILC) promises better cosmetic results and probably less pain compared with conventional laparoscopy. METHODS: In a period of 5 months, data were collected and analyzed from patients, who underwent SILC using the Glove port. Another group of patients who underwent standard laparoscopic cholecystectomy during the same period has been taken as control group. Demographic data, operative time, successfulness of operation, length of hospital stay, and postoperative findings were collected. RESULTS: Twenty-five patients underwent SILC and 30 patients underwent the standard procedure. There were no conversions to open procedure in either group. No major complications occurred. Operative time in SILC cases was significantly more than the standard technique, whereas postoperative pain in the SILC group was considerably less. CONCLUSIONS: It seems that in selected patients (with a low risk of adhesions or technical difficulty), SILC can be an acceptable alternative to standard laparoscopic cholecystectomy with acceptable results.

Nonoperative management of anterior thoracoabdominal stab wounds in selected patients.

OBJECTIVES: Nowadays, use of selective nonoperative management has decreased the incidence of nontherapeutic laparotomies in patients with anterior thoracoabdominal stab wounds. The safety of selective nonoperative management was investigated in these patients, not requiring emergency laparotomy. PATIENTS AND METHODS: Patients referred to the Tabriz Imam Reza Hospital with anterior thoracoabdominal stab wounds were studied from August 2008 to 2010. The hemodynamically unstable patients, those with evidence of peritoneal irritation or with organ evisceration, underwent an emergency laparotomy. For other patients, diagnostic peritoneal lavage (DPL) was used and patients with positive results were operated. Patients with negative DPL results underwent serial physical and laboratory examinations. RESULTS: A total of 204 patients were studied. Sixty-two cases (30.4%) had emergency operations, with 12 (19.4%) cases of nontherapeutic laparotomies. On the basis of DPL results in 142 (69.6%) patients, laparotomy was carried out in another 18 (12.7%) cases with a nontherapeutic result in eight (5.6%) cases. Finally, 124 (60.8%) patients were left for further observation and serial physical and laboratory examinations. Accordingly, five (4%) patients needed delayed laparotomy without any serious complications due to the delayed operation. The length of hospital stay and nontherapeutic laparotomies in our study were lower than mandatory laparotomy management and also, there were no significant complications or mortalities within the 90 days follow-up period. CONCLUSION: This study showed that the proposed approach of selective nonoperative management in patients with anterior thoracoabdominal stab wounds is safe, feasible, and probably cost-effective.

Relaparoscopy in minor bile leakage after laparoscopic cholecystectomy: an alternative approach?

PURPOSE: Bile leakage is one of the most important complications of laparoscopic cholecystectomy, and it has been recognized as a major clinical challenge during the last 2 decades. Although endoscopic and percutaneous interventions are widely accepted in the management of bile leakage, relaparoscopy permits the bile drainage adequately and gives direct control of bile leakage site in selected patients. METHODS: Data for patients with minor bile leakage after laparoscopic cholecystectomy were collected from January 2001 to January 2010. Patients were categorized in 2 groups, nonoperative and relaparoscopy. Clinical presentation, kind of management, and outcomes were evaluated in 2 groups. RESULTS: After a total of 2652 laparoscopic cholecystectomies, postoperative minor bile leakage occurred in 17 (0.64%) patients. Four patients with minimal leakage were managed by percutaneous drainage alone. Endoscopic retrograde cholangiopancreatography was applied to 4 patients with jaundice, high output bile fistula, and a patient with retained common bile duct stone. Bile leakage was controlled in 3 of the 4 patients. There were 9 patients in the relaparoscopic group to which 1 patient was added after unsuccessful endoscopic intervention. The source of bile leakage in the relaparoscopic cases was defined as 50% from cystic duct stump and 50% from Luschka or accessory ducts. The success rate of bile leakage control after relaparoscopy was 90%. The mean of hospital stay after relaparoscopy was 3 days (range, 2-10 d) and after endoscopic retrograde cholangiopancreatography intervention or percutaneous drainage was 10 days (range, 3-28 d). CONCLUSIONS: Relaparoscopy is an effective procedure in the management of minor bile leakage after laparoscopic cholecystectomy and can be an alternative approach in selected situations.

Hormone receptor status in breast cancer and its relation to age and other prognostic factors.

BACKGROUND: Increasing evidence shows the importance of young age, estrogen receptor (ER), progesterone receptor (PR) status, and HER-2 expression in patients with breast cancers. PATIENTS AND METHODS: We organized an analytic cross-sectional study of 105 women diagnosed with breast cancer who have been operated on between 2008 to 2010. We evaluated age, size, hormone receptor status, HER-2 and P53 expression as possible indicator of lymph node involvement. RESULTS: There is a direct correlation between positive progesterone receptor status and being younger than 40 (P < 0.05). Also, compared with older women, young women had tumors that were more likely to be large in size and have higher stages (P < 0.05). Furthermore patients with negative progesterone receptor status were more likely to have HER-2 overexpression (P < 0.05). The differences in propensity to lymph node metastasis between hormone receptor statuses were not statically significant. CONCLUSIONS: Although negative progesterone receptor tumors were more likely to have HER-2 overexpression, it is possible that higher stage and larger size breast cancer in younger women is related to positive progesterone receptor status.

Bowel perforation by ventriculoperitoneal shunt catheter mimicking gastroenteritis.

Colon perforation is a rare and serious complication of ventriculoperitoneal shunt. The authors report a 7-month-old male infant with vomiting and watery diarrhea after colon perforation by a ventriculoperitoneal shunt. A minimal laparotomy incision was performed accurately where preoperative colonoscopy had detected the penetration site of shunting tube in the left colon.