Incidence and Factors Contributing to Low Back Pain in the Nonobstetrical Patients Operated Under Spinal Anesthesia: A Prospective 1-Year Follow-Up Study.

PURPOSE: To determine the incidence and factors contributing to postspinal anesthesia (SPA) low back pain (LBP) in patients undergoing nonobstetrical surgeries. DESIGN: A prospective 1-year follow-up study. METHODS: Patients having nonobstetrical surgery using SPA were included. The patients were followed up through phone calls and interviews every postoperative day for the first week, weekly for a month, and then monthly for a year after SPA. Patients' duration of LBP, duration of surgery, and need for LBP treatment were recorded. FINDINGS: Of 410 patients, 5.8% (24 patients) experienced LBP. The incidence of LBP did not have a significant correlation with the recorded variables (P > .05). There was a negative significant correlation between duration of LBP and duration of surgery (r = -0.5096; P = .001). Of the 24 patients experiencing LBP, 16.7% (four patients) experienced it for less than 1 day, 66.7% (16 patients) 1 to 7 days, 16.7% (four patients) more than 7 days, and only one patient (4.2%) for up to 17 days. Special LBP treatment was not needed in any of the patients. CONCLUSIONS: The incidence of LBP was very low, and those patients undergoing nonobstetrical surgery and receiving SPA did not experience persistent LBP.

Effect of TENS on Postoperative Pain and Pulmonary Function in Patients Undergoing Coronary Artery Bypass Surgery.

BACKGROUND: The aim of this study was to determine the effect of electrical nerve stimulation on pain intensity and pulmonary function in patients undergoing coronary artery bypass surgery. MATERIALS AND METHODS: In a randomized clinical trial, a total of 100 patients undergoing coronary artery bypass surgery at Masih Daneshvari Hospital, Tehran, Iran, from February to May 2014, were divided into two groups. In the intervention group (n = 50), patients received routine care along with transcutaneous electrical nerve stimulation (TENS) immediately after admission to the intensive care unit (ICU). In the placebo group (n = 50), patients only received routine care. The pain intensity was measured using a visual analog scale (VAS) every 6 hours for 72 hours after surgery in two conditions of rest and coughing. Pulmonary function was assessed through forced expiratory volume in 1 second (FEV1) and forced volume capacity (FVC) at 24, 48, and 72 hours after surgery. Age, gender, body mass index, narcotic consumption, ICU length of stay, and requests for chest radiographs were recorded. The statistical level of significance was set at p < .05. RESULTS: There were no significant differences between the two groups in terms of age, gender, and body mass index (p > .05). Pain intensity was significantly lower in the TENS group than the placebo group in both resting and coughing condition (p < .05). FVC and FEV1 were significantly better and faster in the TENS group than in the placebo group at 24, 48, and 72 hours after surgery (p < .05). Patients in the TENS group had significantly lower narcotic use and requests for chest radiographs compared with placebo group. CONCLUSIONS: TENS may reduce postoperative pain in resting and coughing conditions, improve pulmonary function, and reduce narcotic use in patients undergoing coronary artery bypass surgery.

Prevalence of aspirin resistance in patients with type II diabetes: a descriptive-analytical study
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BACKGROUND: Aspirin resistance is one of the most important factors for arterial thrombotic events in diabetic patients. This study aimed to evaluate aspirin resistance in diabetic patients. METHODS: In this cross-sectional study, 180 patients who received 80 mg of aspirin daily for at least 10 days were studied, and their urinary 11-DH-TXB2 was measured. Those with 11-dehydro-thromboxane B2 above 1,500 pg/mg creatinine were considered aspirin resistant. Data with significance level of 5% were analyzed in SPSS-16. RESULTS: The mean ± SD of patient age was 60.22 ± 9.59 years and 50% (n = 90) were male. BMI was normal in 29.4% of the patients (n = 53), the others were overweight or obese. Aspirin resistance was observed in 33 (18%) patients. The relationship between aspirin resistance and gender, age, and BMI was not significant (p > 0.05). CONCLUSIONS: There is a high prevalence of aspirin resistance in diabetic patients and given that such patients are at risk of arterial thrombotic events, evaluation of aspirin resistance is suggested for those at a high risk of cardiovascular events or recurring events despite the use of aspirin.
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Unusual cause of breast wound: postoperative pyoderma gangrenosum.

Postoperative pyoderma gangrenosum (PPG) is an unusual clinical entity, which shows rapidly progressive skin necrosis that can occur within surgical sites after any surgical procedure. Usually, it is diagnosed as wound infection at the time of presentation, but antibiotic therapy and wound debridement fail to arrest rapid ulcer enlargement. We report the case of PPG in a 21-year-old woman after a reduction mammoplasty surgery. In this report, we emphasise the importance of considering pyoderma gangrenosum (PG) as one of the differential diagnoses of breast ulcers after surgical procedures. Careful clinical assessment may establish an early diagnosis and prevent potential serious complications.

Surgical treatment of primary intracardiac myxoma: 20-year experience in "Shahid Modarres Hospital"--a tertiary university hospital--Tehran, Iran.

UNLABELLED: Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. METHOD: Patients data of 20 years was collected and evaluated in the "Shahid Modarres Hospital"--a tertiary university hospital--Tehran, Iran. RESULTS: 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22 cm (range of 2.2 to 8.2 cm). Postoperatively, 33 patients discharged from hospital without any complication. DISCUSSION: The research reveals that patients' age and gender were similar to that of other studies in other countries while tumor's incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. CONCLUSION: In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out.

The effect of local injections of bupivacaine plus ketamine, bupivacaine alone, and placebo on reducing postoperative anal fistula pain: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. METHOD: In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. RESULTS: Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P < 0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P < 0.05). CONCLUSION: Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.

Tracheostomy in Patients Who Need Mechanical Ventilation: Early or Late? Surgical or Percutaneous? A Prospective Study in Iran.

Tracheostomy can be performed surgically or by percutaneous (percutaneous dilatory tracheostomy, PDT) methods, and it may be used early or late. In a 3-month follow-up, all patients who underwent tracheostomy in Semnan in 2013 were evaluated for complications of tracheostomy considering the method used and the timing of operation. A total of 55 patients underwent tracheostomy (26 cases surgery, 29 cases PDT, 30 cases early, and 25 cases late based on 14 days reference). The mean durations of operation were 19.19 ± 5.78 min in the surgery method and 4.7 ± 2.42 min in the PDT method (P < 0.001). The mean durations of the need for ventilator after the tracheostomy were 10.7 ± 9.25 and 18.6 ± 14.39 days in early and late tracheostomy, respectively (P = 0.024). The mean intensive care unit (ICU) stay were 12.70 ± 10.24 and 23.44 ± 18.49 days (P = 0.014) and the mean hospital stay were 16.04 ± 10.88 and 23.48 ± 18.47 days, respectively (P = 0.100). Short-term complications were observed in six cases (10.09 %) in the surgery group, including emphysema (two), bleeding (two), wound infection (one), and clot formation inside the tube (one). Only one complication (bleeding) occurred in one case in the PDT group. After 3 months, 21 patients survived. Compared with surgery, the most important advantage of the PDT method was its shorter duration of surgery. Nearly half of the patients underwent tracheostomy late, while the majority of the patients in the late group were referred from internal ICU. No major and minor complications were noted during the procedure, as well as no tracheostomy-related deaths were observed. Early tracheostomy was shown to be superior to late, reducing the time of mechanical ventilation and ICU or hospital stay.

Effect of Desmopressin on the Amount of Bleeding and Transfusion Requirements in Patients Undergoing Heart Transplant Surgery.

One of the most common risks after a heart transplant is bleeding. In this study, the effect of desmopressin administration on the amount of bleeding and transfusion requirements after heart transplant surgery was investigated. In a double-blind clinical trial, 48 patients who were candidates for heart transplant surgery were randomly assigned to two groups. In the intervention group, patients received desmopressin of 0.3 µg/kg, 30 min. before surgery. Patients in the control group received normal saline at the same amount and time. Homeostasis was evaluated using activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after surgery, and also, chest tube drainage, blood products transfusion requirements during the first day in both groups. No significant differences were found between the groups in terms of ACT, PT, PTT and PLT at all times. Transfusion of packed red blood cells and the mean drainages of chest tube during the first 24 hr after surgery were significantly lower in the desmopressin group compared to the saline group. Desmopressin may reduce post-operative bleeding in patients undergoing heart transplant surgery. Further studies are required to confirm the potential effect of desmopressin on establishing haemostasis after heart transplantation.

Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery.

Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC) for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012-2015) were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery.

Small bowel obstruction attributable to phytobezoar.

Small bowel obstruction (SBO) is a common condition encountered in surgical practice. Literature shows divers and many different etiologies for intestinal obstruction. However, bezoars are rarely reported as an etiological factor. A bezoar happens most commonly in patients with impaired gastrointestinal motility. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobezoars. The most common type is phytobezoars, which are composed of undigested fiber from vegetables or fruits especially persimmons. They are mostly composed of cellulose, tannin and lignin. The commonest phytobezoar reported worldwide is related to the persimmon fruit ingestion. The most common symptom of bezoar-induced SBO is abdominal pain (96-100%). Other common symptoms include nausea and vomiting. Primary small bowel phytobezoars almost always present as SBO. We present an unusual case of SBO caused by a phytobezoar in a 35-year-old patient. Many types of bezoar can be removed endoscopically, but some will require operative intervention.

Short term effects of kinesio taping on pain and functional disability in young females with menstrual low back pain: A randomised control trial study.

BACKGROUND: Menstrual low back pain (LBP) in young females can reduce daily activity and cause functional disability, while the progressive application of kinesio-taping (KT) on pain reduction and functional correction has been stated. OBJECTIVE: This study has been designed to investigate the efficacy of the lumbar vertebral column KT in young female with menstrual LBP. METHODS: Thirty-two young females with menstrual LBP participated in this crossover study and were assigned randomly in two separate groups. The first group received KT during their first menstrual cycle and No-KT in their next menstrual, while the other group had no KT during the first mentrual cycle and received KT during the next menstrual cycle. The primary outcome measurements included the visual analogue scale (VAS) of pain, Oswestry disability index and McGill pain questionnaire score which were planned to collect at the end of the third day of the menstrual cycle. RESULTS: Comparing pain and disability between two conditions, of menstrual cycle with KT and menstrual cycle without KT, revealed significant reduction in VAS (mean change = 1.7; 95%CI = 0.6 to 2.8; P= 0.005), McGill pain score (mean change = 20.1; 95%CI = 8.7 to 31.3; P= 0.001) and functional disability (mean change = 12.3; 95%CI = 7.2 to 17.5; P< 0.0001) by using KT during menstrual cycle. CONCLUSIONS: Results showed that KT may effectively reduce pain and disability. The findings may support the clinical application of kinesiotaping in young females with menstrual LBP.

Six-month follow-up study of ultrarapid opiate detoxification with naltrexone.

BACKGROUND: Illicit opiate use has an increasing incidence and prevalence, which increases mortality and morbidity, marginalization, and criminal behaviors, and causes major adverse effects on society. OBJECTIVES: This study aimed to investigate and follow the outcome of patients who underwent ultrarapid opiate detoxification (UROD) prospectively. PATIENTS AND METHODS: In this randomized clinical trial, 64 patients who underwent UROD were evaluated. The opiate antagonist regimen of naloxone was administered intravenously under general anesthesia, and detoxification was confirmed by naloxone challenge test. All patients were cared in intensive care unit (ICU) for 24 hours, and oral naltrexone was prescribed the next day, after recovery and discharge. Patients were followed up for one month after the procedure. Relapse was considered if routine use of opiates (daily use for at least two weeks) was reported by the patient after detoxification. The data was analyzed by SPSS 16.5 and the study was performed using descriptive analysis and Chi square test. RESULTS: All 64 participants were opiate-dependent males (ASA physical status of I or II) who aged over 18 years with a mean age of 31.11 ± 8.93 years at the time of UROD. One month after UROD, 48 patients (75%) reported relapse and 16 (25%) reported abstinence; however, four patients of the non-relapsed group reported one episode of opiate use. There was no significant difference between relapsed and non-relapsed patients regarding their marital status, level of education, and family history of opiate dependency (P > 0.05). CONCLUSIONS: Although UROD by naloxone is a safe and effective method of detoxification, if used alone, it has a very high relapse rate in long term.