Publications by authors named "Ahmadreza Mirbolook"

23 Publications

  • Page 1 of 1

Iatrogenic injury to long thoracic nerve following thoracotomy for right thoracic scoliosis in Marfan syndrome: a case report.

J Med Case Rep 2021 Mar 26;15(1):167. Epub 2021 Mar 26.

School of Medicine, Capital Medical University, Beijing, China.

Background: Patients with Marfan syndrome commonly require spinal deformity surgery. The purpose of this case report is to present a rare thoracotomy complication. We present the management of such a patient. In a known case of Marfan syndrome, an 18-year-old Persian man was admitted to our hospital with scoliosis. The patient underwent radiological examinations, and thoracic scoliosis of 70° was diagnosed. A right thoracotomy for anterior spinal fusion from the sixth rib and posterior spinal fusion were performed successfully. Two months later, he was readmitted because of winging of the right scapula due to serratus anterior palsy. Electromyography and nerve conduction velocity confirmed long thoracic nerve injury. Conservative treatment was provided. Ultimately, the patient recovered completely in the last follow-up visit 6 months after the surgery.

Discussion: This is the first report of ipsilateral winged scapula after thoracotomy. Attention needs to be paid to surgical techniques in patients with Marfan syndrome.
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http://dx.doi.org/10.1186/s13256-021-02755-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995720PMC
March 2021

Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery?

Arch Bone Jt Surg 2018 Sep;6(5):390-396

Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority of these patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purpose of this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in terms of hemodynamic changes in patients undergoing hip fracture surgery.

Methods: This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture under spinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half an hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection.

Results: Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASA Class, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster than group B (). Also, the durations of sensory and motor blocks in group B were significantly longer than group BL ). The BL group had a significantly lower systolic blood pressure in all periods (). Although the heart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3 ( and , respectively). Group BL had significantly more episodes of hypotension, bradycardia, nausea and vomiting (, , , and , respectively).

Conclusion: According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared with Bupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotension and bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for induction of anesthesia in these patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168228PMC
September 2018

The Relationship between Plasma Levels of Interleukin-6, Multiple Organ Dysfunction and Mortality in Orthopedic Patients.

Iran J Immunol 2018 Jun;15(2):156-164

Taleghani Hospital, Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.

Background: Interleukin 6 (IL-6) functions as both a pro-inflammatory cytokine and an anti-inflammatory cytokine.

Objective: To evaluate the levels of IL-6 in patients with multiple organ dysfunction syndrome (MODS).

Methods: Level of IL-6 was assessed and recorded for 14 days subsequent to the injury in 161 multiple trauma patients. MODS were diagnosed using Marshal Score. Injury Severity Scoring (ISS) was measured for all patients.

Results: The results of this study indicated that there was a significant relationship between the level of IL-6 and ISS on the first and second days post trauma (P=0.0001). The high level of IL-6 on the second day post trauma was associated with high mortality rate.

Conclusion: Our study suggests the second day as the golden time for measuring the serum levels of IL-6. These findings warn us to take more health care actions in patients with higher serum levels of IL-6 on the second day.
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http://dx.doi.org/IJIv15i2A8DOI Listing
June 2018

A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia.

Arch Bone Jt Surg 2018 Jan;6(1):63-70

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Several studies have put an effort to minimize the tourniquet pain and complications after conventional double tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm single wide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT) in distal upper extremity surgeries.

Methods: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomized into two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visual analogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distal tourniquet while fentanyl 50µg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximum tourniquet pain and the amount of fentanyl consumption were compared between the two groups.

Results: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1) in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (). The median of time to reach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating that the patients in ST group reached to pain level at a significantly later time (). The total opioid consumption in the DT group (61 µg) was significantly lower than the ST group (102 µg) (); however, both groups were similar regarding fentanyl consumption before 40 minutes of surgeries.

Conclusion: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquet may serve as a proper alternative opposed to the conventional double tourniquet technique. II.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799603PMC
January 2018

Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane Anesthesia in Patients Undergoing Hip Fracture Surgery.

Arch Bone Jt Surg 2017 Jul;5(4):226-230

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.

Background: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery.

Methods: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups.

Results: During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group.

Conclusion: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592363PMC
July 2017

Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Arch Bone Jt Surg 2017 Mar;5(2):103-108

Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Poursina hospital, Rasht, Iran.

Background: Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting.

Methods: Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups.

Results: Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894).

Conclusion: Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410741PMC
March 2017

Predicting the Hamstring Tendon Diameter Using Anthropometric Parameters.

Arch Bone Jt Surg 2016 Oct;4(4):314-317

Guilan Road Trauma Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Background: Despite the importance of hamstring tendon autograft, one major disadvantage in applying this technique in the surgical reconstruction of anterior cruciate ligament is individual variability in the tendon diameter. Hence, the purpose of the present study was to use anthropometric parameters such as gender, height and body mass index to predict 4-strand (quadruple) hamstring tendons (gracilis and 2-strand semitendinosus tendons).

Methods: This is a cross-sectional study conducted on all consecutive patients who underwent arthroscopic ACL reconstruction between 2013 and 2015. The anthropometric variables (age, gender, height, and body mass index) were recorded. The quadruple hamstring tendon (gracilis and semitendinosus) autografts were measured using sizing cylinders. The relationship between these parameters was statistically determined using the Pearson Spearman test and linear regression test.

Results: The mean age of the 178 patients eligible for the study was 29.58±9.93 (118 males and 60 females). The mean hamstring tendon diameter was 7.8±0.7 mm, the mean for males was 7.9±0.6 and for females 7.8±9 mm (=0.0001). There were significant correlations between the mean hamstring tendon diameter with BMI (Pearson correlation=0.375, R=0.380, and =0.0001), height (Pearson correlation=0.441, R=0.121, and =0.0001), and weight (Pearson correlation=0.528, R= -0.104 and =0.0001). However, patient's age and genderwerenot found to be a predictor of the size of the hamstring tendon diameter.

Conclusion: Based on findings from this study weight, height, body mass index, and the length of the tendon may be predictors of the hamstring tendon diameter for anterior cruciate ligamentreconstruction. These findings could be used in preoperative planning of patients undergoing ACL reconstruction surgery to estimate the size of the graft and select of the appropriate type of graft.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100445PMC
October 2016

The Relation Between Reflex Sympathetic Dystrophy Syndrome and Trauma Severity in Patients With Distal Tibia Fracture.

Trauma Mon 2016 May 1;21(2):e25926. Epub 2016 May 1.

Medical Faculty, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Reflex sympathetic dystrophy (RSD) syndrome is a multifactorial disorder with clinical features of neurogenic inflammation that causes hypersensitivity to pain or severe allodynia as well as blood flow problems, swelling, skin discoloration and maladaptive neuroplasticity due to vasomotor disorders. Patients with major trauma are prone to homeostasis leading to inflammatory response syndrome and multiple organ distress syndrome. Several studies have investigated the etiology of this condition, but the cause remains unknown. The role of associated factors such as the limb immobilization technique and genetics has been reported in the development of this complication, but, so far, there is no information regarding the effect of trauma severity on the risk of RSD occurrence.

Objectives: Given the importance of diagnosing and treating this condition, we aimed to study the effect of trauma severity on the prevalence of RSD.

Patients And Methods: In this cross-sectional study, we examined patients with distal tibial fracture who visited Rasht Poursina hospital from 2010 to 2013. Exclusion criteria included associated fractures, underlying musculoskeletal diseases and mental and cognitive problems. To assess the severity of the initial injury in patients, the Hannover Fracture Scale 98 (HFS98) scoring checklist was used. The diagnosis of RSD was made on the basis of the IASP criterion. Demographic data, HFS98 scores, and information regarding RSD prevalence were analyzed using SPSS version 20. The Mann Whitney U nonparametric test was used for variables that were not normally distributed; the chi-square test was used to compare the qualitative variables.

Results: Among the 488 patients, 292 (59.83%) were male. The mean age of the study population was 44 ± 9.82 years. During the 6-month follow-up, RSD occurred in 45 patients, of whom 28 (62.22%) were female and 17 (37.77%) were male; there was thus a significant difference in the prevalence of RSD in terms of gender (P = 0.00; chi square test). The mean HFS98 score in patients without and with RSD was 3.081 ± 4.083 and 4.080 ± 4.622, respectively, and the difference was not statistically significant (P = 0.363; Mann Whitney U test). Analyses of the eight items of HFS98 shows that local circulation in patients with RSD is significantly better than that in patients without RDS (0.683 ± 0.822 vs. 0.528 ± 0.629, respectively). Statistical analysis showed that the odds ratio for RSD for patients with HFS95 score > 0 was 1.079 (confidence interval [CI]: 0.898 - 1.333). Moreover, the odds ratio for RSD was 1.100 (CI: 795 - 1.531) in patients with an injury severity score higher than the calculated mean score in patients without RSD (> 4.083).

Conclusions: The results suggest no significant relationship between the severity of injury and risk of RSD occurrence, although the mean injury severity score was higher in patients with RSD than in those without RSD in this study population. The lower score of local circulation in patients with RSD than in those without RSD is a statistically significant finding and can be attributed to changes in the antioxidant levels at the injury site, which is one of the main mechanisms for the onset of RSD. Wound contamination was also justifiably higher in patients with RSD, although the difference was not statistically significant. In summary, the severity of injury alone cannot be a determining factor for predicting the probability of RSD.
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http://dx.doi.org/10.5812/traumamon.25926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003432PMC
May 2016

The Impact of Psychological Factors on Device Removal Surgery.

Trauma Mon 2016 May 8;21(2):e25871. Epub 2016 May 8.

Medical Faculty, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Implant removal is a common procedure in orthopedic surgery which can be associated with many complications such as scar formation, hematoma, nerve injury, infection, and refracture. Indications for orthopedic implant removal have declined in recent years. Most studies have considered orthopedic hardware removal as an unnecessary procedure in the absence of severe complications such as nonunion. Some studies have reported the complications of orthopedic hardware removal to be 24% to 50% dependent on their types and locations as well as on other factors such as patient's condition and the orthopedist's experience.

Objectives: The present study surveyed possible mental and psychological causes among patients who asked for removal procedures in spite of orthopedic surgeons' advice and being aware of complications.

Patients And Methods: Patients who had undergone plating for the treatment of radius and ulna fractures from 2011 to 2013, were told that it is not necessary to remove the plate and they were warned of all the risks of removal surgery, such as anesthesia, possible nerve or vascular damage, and the cost of surgery. Then, their tendency to remove the plate was examined based on evaluation criteria scores. Patients were divided into two groups: patients who insisted on surgery despite all the risks and patients who had little tendency or gave up after explanations. Both groups were given visual analog pain scale (VAS), symptom checklist-90 (SCL-90), and pain catastrophizing scale (PCS) questionnaires. The questions were explained for patients by an expert trained in the clinic and in case of ambiguity further explanations were given to the patients. The data were then entered into statistical package for the social science (SPSS) version 20 for analysis.

Results: A total of 29 patients with plates were enrolled. The first group consisted of 16 male and 13 female patients. In the control group (group II), there were 30 patients with no tendency for plate removal. In this group, 15 patients were male and 15 were female. The mean age of the first group was 38.25 ± 11.12 years and for the second group it was 36.82 ± 12.01 years. There was no significant difference between the two groups in terms of age and gender. Mean discomfort of patients was 7.75 ± 1.74 in the first and 3.96 ± 1.90 in the second group, indicating a statistically significant difference (P = 0.000). Mean VAS score was 3.96 ± 1.20 in the first group and 3.80 ± 1.15 in the second group, which was not statistically significant (P = 0.593). Mean daily pain and discomfort was 10.62 ± 3.09 hours in the first and 4.86 ± 2.23 hours in the control group, indicating a statistically significant difference (P = 0.000). Linear regression analysis results demonstrated a significant correlation between increased VAS scores in the first group (P = 0.000), but it was not significant in the second group (P = 0.083). The results also showed that increase in time of daily pain and discomfort had a linear relationship with increased discomfort score in both groups (P = 0.00). Mean pain catastrophizing scale (PCS) score was 10.13 ± 3.62 in the first and 9.56 ± 3.07 in the second group, which was not statistically significant. Mean somatization score was 52% ± 6.53% and 47.96% ± 7.17% in the first and second groups, respectively, which showed no significant differences (P = 0.013). Obsessive compulsive score was 54.63 ± 5.34 in the first and 46.63 ± 4.49 in the second group, which was statistically significant (P = 0.000).

Conclusions: Mental and psychological backgrounds can affect the severity of discomfort of the implant. Given that so far the present study is the only study investigating the relationship between mental criteria and tendency of patients for implant removal, further studies with larger sample sizes seem warranted.
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http://dx.doi.org/10.5812/traumamon.25871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003471PMC
May 2016

Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain.

Trauma Mon 2016 May 20;21(2):e20718. Epub 2016 Mar 20.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography).

Objectives: The purpose of this study was to compare the diagnostic value of these two methods.

Patients And Methods: The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings.

Results: In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1).

Conclusions: Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies.
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http://dx.doi.org/10.5812/traumamon.20718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003469PMC
May 2016

Distal clavicular fracture treatment with suture anchor method.

Acta Orthop Traumatol Turc 2016 ;50(3):298-302

Department of Orthopedics and Traumatology, Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Objective: The aim of this study was to evaluate the results of the suture anchor fixation in the treatment of distal clavicle fractures.

Methods: This cross series study included 43 patients (27 males, 12 females; mean age: 40.1±10.18 years) with type II unstable distal clavicle fractures. The fractures were fixed by 2 pins and 1 suture anchor. All patients were followed at postoperative months 3, 6, and 12 and underwent clinical and radiographic evaluation after 1 year, ongoing at 6-month intervals thereafter. Demographic data were recorded on the first postoperative day. At third and 12th month follow-up, Constant-Murley Shoulder Outcome Score (CMS) was used to assess performance of the acromioclavicular joint, and Visual Analog Scale questionnaire was used to assess patient satisfaction.

Results: Based on CMS scores 1 year after surgery, 37 patients were in excellent condition, and 2 patients were in good condition. Mean surgical case duration was 43.25±4.01 min. These results indicate that there was no significant association between CMS scores and surgical case duration. Mean time to union in our patients was 4.46±0.96 months.

Conclusion: We were able to observe optimal results in our patients by using closed reduction and suture anchors without opening the fracture site, thus allowing physiological processes in union without complications of complete union, while also preventing additional costs such as removing the device.
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http://dx.doi.org/10.3944/AOTT.2015.15.0023DOI Listing
February 2017

Subtrochanteric Fractures: Comparison of Proximal Femur Locking Plate and Intramedullary Locking Nail Fixation Outcome.

Indian J Surg 2015 Dec 16;77(Suppl 3):795-8. Epub 2013 Nov 16.

Internal Medicine Resident, Qazvin University of Medical Sciences, Qazvin, Iran.

Fixation of subtrochanteric fracture, even for experienced surgeons, is a challenge. This fracture is most difficult to treat, and the incidence of complications in this type of fracture is higher. This study compared surgical results of two methods, proximal femur locking compression plate and intramedullary locking nail. This is an analytic study, performed on all patients with subtrochanteric fracture who were referred to the hospital during 3 years. They were treated with proximal femur locking plate or intramedullary locking nail. The postoperative complications were evaluated and recorded. Finally, the data were analyzed by SPSS software. Complications were studied in both groups. Neither treatment has statistically significant difference in complications, onset of complications incidence, and time of full-weight bearing. Although the Harris Hip Score among patients improved in both methods of treatment, there is no significant difference between the two groups. The results of subtrochanteric fracture fixation by intramedullary or locking plate were similar and had the same outcome.
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http://dx.doi.org/10.1007/s12262-013-1004-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775634PMC
December 2015

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center.

Arch Bone Jt Surg 2016 Jan;4(1):70-4

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management.

Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status.

Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9.

Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733240PMC
January 2016

Association of Soccer and Genu Varum in Adolescents.

Trauma Mon 2015 May 25;20(2):e17184. Epub 2015 May 25.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Genu varum is a physical deformity marked by bowing of the leg. One of the risk factors of this musculoskeletal alignment is stress on the knee joint such as with exercise.

Objectives: Since the evaluation of genu varum has not been widely studies, this study was conducted to examine the association between genu varum and playing soccer.

Materials And Methods: Between Septembers 2010-2012, 750 soccer players and 750 non-soccer players 10-18 years of age were included in the study. A questionnaire of data including age, height, weight, body mass index (BMI), years of soccer participation, the average time of playing soccer per week, previous trauma to the lower limbs, history of any fractures of the knee, previous hospitalizations, and the distance of joint lines between the knees was assessed for all subjects. Chi-square, student t-test, and one-way ANOVA were used for statistical analysis by SPSS v.19.0 software. In all tests, a P value of less than 0.05 was construed as statistically significant.

Results: Both soccer players and controls had genu varum. However, the incidence of genu varum was higher in the soccer players (P = 0.0001) and it was more prevalent in the 16-18 year age group (P = 0.0001). The results revealed a statistically significant association between the degree of practices and the prevalence of genu varum (P = 0.0001). Moreover, previous trauma to the knees and practicing in load-bearing sports led to an increase in the degree of genu varum (P = 0.0001).

Conclusions: There was a higher incidence of genu varum in soccer players than in control adolescents; the stress and load imposed on the knee joint led to more severe genu varum.
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http://dx.doi.org/10.5812/traumamon.17184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538725PMC
May 2015

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

J Foot Ankle Surg 2015 Nov-Dec;54(6):1047-52. Epub 2015 Jul 26.

General Practitioner and Researcher, Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (<6-week duration) symptomatic plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm(2) and a total energy flux density of 900 mJ/mm(2) for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p < .0001). In the ESWT and CSI groups, 19 (55.9%) and 5 (14.7%) patients experienced treatment failure, respectively. Age, gender, body mass index, and recurrence rate were similar between the 2 groups (p > .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes.
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http://dx.doi.org/10.1053/j.jfas.2015.04.026DOI Listing
August 2016

Effect of Intravenous Intraoperative Esmolol on Pain Management Following Lower Limb Orthopedic Surgery.

Korean J Pain 2015 Jul 1;28(3):198-202. Epub 2015 Jul 1.

Qazvin University of Medical Sciences, Qazvin, Iran.

Background: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery.

Methods: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant.

Results: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026).

Conclusions: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.
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http://dx.doi.org/10.3344/kjp.2015.28.3.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500784PMC
July 2015

The effect of magnesium sulfate on motor and sensory axillary plexus blockade.

Anesth Pain Med 2015 Feb 1;5(1):e21943. Epub 2015 Feb 1.

Anesthesiology Research Centre, Guilan University of Medical Sciences, Rasht, Iran.

Background: Magnesium is a physiologic cation that blocks neuromuscular transmission and does not allow the nerve to be stimulated.

Objectives: This study investigates the effect of adding magnesium sulfate to lidocaine to extend the duration of sensory and motor blocks of the axillary plexus in orthopedic surgeries of the upper extremities.

Patients And Methods: This controlled randomized double-blind study was performed on patients who were candidates for orthopedic surgery of the upper extremities. A total of 60 patients between 18-60 years with ASA Class 1 or 2 participated in the study. One group received lidocaine (5 mg/kg) with magnesium sulfate 20% (3 mL) as the case group, while the second group received lidocaine (5 mg/kg) with normal saline (3 mL) as a placebo to block the axillary plexus using the trans-arterial technique. The duration of the sensory and motor block of the axillary plexus was monitored and evaluated using the pinprick and modified Bromage scale.

Results: A total of 60 patients were included in the study with 30 patients having received lidocaine plus magnesium and the other 30 patients having received lidocaine plus normal saline. The mean sensory block duration in the case group was 248.83 ± 18.36 and in control group was 204.67 ± 22.62. The mean motor block duration in the case group was 207.0 ± 16.64 and in control group was 147.33 ± 21.52 (both P < 0.0001). The mean onset of sensory block in case group was 15.5 ± 3.79 and the onset block in control group was 10.33 ± 4.13 (P < 0.0001). The mean onset of motor block in case group was 20.66 ± 4.09 and the onset block in control group was 19.73 ± 26.18 (P < 0.848).

Conclusions: The addition of magnesium sulfate to lidocaine increased the duration of motor and sensory axillary block in the upper extremities during surgeries when compared to the use of lidocaine alone.
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http://dx.doi.org/10.5812/aapm.21943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363737PMC
February 2015

Effect of obesity on arthroscopic treatment of anterolateral impingement syndrome of the ankle.

J Foot Ankle Surg 2015 Jan-Feb;54(1):13-6. Epub 2014 Oct 24.

Medical Student, Student Research Center, Guilan University of Medical Sciences, Rasht, Iran.

The present case series study was performed to evaluate the effect of obesity on the arthroscopic findings and the functional outcome after arthroscopic treatment of anterolateral impingement syndrome of the ankle. The study was conducted on 36 patients (26 were classified as obese [body mass index ≥30 kg/m(2)] and 10 as not obese [body mass index <25 kg/m(2)]) who had previously undergone arthroscopic treatment of anterolateral impingement syndrome of the ankle. The arthroscopic findings and demographic features were recorded. The patients were examined postoperatively at 6 and 12 months postoperatively, and AOFAS scores were obtained. Our data showed that obese patients had the same arthroscopic findings as nonobese patients, except for chondral lesions. At 1 year of follow-up after performing arthroscopy, the presence of obesity had no effect on the functional outcome of arthroscopic treatment of anterolateral impingement syndrome of the ankle.Obesity has no effect on the effectiveness of arthroscopic treatment.
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http://dx.doi.org/10.1053/j.jfas.2014.09.005DOI Listing
August 2015

Changes in the serum level of vitamin d during healing of tibial and femoral shaft fractures.

Trauma Mon 2014 Feb 25;19(1):e10946. Epub 2014 Jan 25.

Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism.

Objectives: The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures.

Patients And Methods: This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week). Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software.

Results: Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001).

Conclusions: Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.
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http://dx.doi.org/10.5812/traumamon.10946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955922PMC
February 2014

Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery.

Anesth Pain Med 2014 Feb 28;4(1):e11334. Epub 2014 Feb 28.

Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Background: Postoperative analgesia is one of the concerns of anesthesiologists and patients. Systemic opioid administration is the gold standard in reducing the severe pain after the surgery but some side effects prevent the use of adequate dosage of opioids.

Objectives: The aim of this study was to evaluate the result of adding magnesium sulphate to sufentanil in patient-controlled intravenous analgesia (PCIA) system.

Patients And Methods: In this randomized clinical trial, 60 patients candidate for lower limb orthopedic surgery were recruited in Poursina Medical Center for six months. They were randomly classified in two group of patient-controlled intravenous analgesia for postoperative pain control, one was group S [(sufentanil) (n = 30)] and the other was group S + M [(magnesium sulphate/sufentanil) (n = 30)]. The drug infusion rate was 5 mL/h. Each mL of solution in group S contained 1 mcg of sufentanil and in group M + S, 1 mcg of sufentanil and 200 mcg magnesium sulphate, respectively. Pain score, sedation score, satisfaction score, nausea and vomiting score were evaluated 6, 12, 24, 36 and 48 hours after surgery.

Results: The demographic data between two groups were not significantly different. The pain scores after 6, 12 and 24 hours in S and S + M groups were significantly different. But the comparison of Visual Analogue Scale (VAS) scores after 36 and 48 hours didn't show significant differences (P < 0.001). Comparison of the sedation, nausea and vomiting scores between two groups did not show any difference. But the number of patient's satisfaction in S + M group was more than S group which suggests significant differences (P < 0.05).

Conclusions: This study showed that magnesium sulphate added to sufentanil through PCIA is an effective method to alleviate pain in patients undergoing lower limb orthopedic surgery. Moreover, we found fewer side effects on magnesium-sufentanil regimen in terms of in nausea, vomiting, and sedation; and patients' satisfaction in this regimen was more rather than that in the regiment of sufentanil alone.
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http://dx.doi.org/10.5812/aapm.11334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961029PMC
February 2014

Fixation of Intertrochanteric Fractures: Dynamic Hip Screw versus Locking Compression Plate.

Trauma Mon 2013 Sep 11;18(2):67-70. Epub 2013 Aug 11.

Student Research Committee, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: According to the existing literature, the Dynamic Hip Screw (DHS) is the preferred standard for the treatment of intertrochanteric fractures. However, some surgeons use other devices such as the Locking Compression Plate (LCP).

Objectives: In this study, we compared the outcome of using DHS or LCP in intertrochanteric fractures.

Materials And Methods: This cross-sectional study was carried out on 104 patients who were referred to Pursina Hospital in Rasht, Iran with intertrochanteric fractures of the femur treated with either the DHS or LCP devices. Demographic features, existence or nonexistence of stability and operating time were obtained from questionnaires. During a 6-month follow-up after surgery, patients were interviewed to record variables such as Harris Hip Scores and complications. The patients were also interviewed on their final visit (between 9 and 31 postoperative months). The collected data was analyzed using SPSS.

Results: We discovered that the number of incidences of limb shortening and device failure was higher for patients treated with the LCP device (P = 0.048 and P = 0.014). Patients treated with the DHS device had higher Harris Hip scores for both the 6-month postoperative and the final evaluation visits (P = 0.01 and P = 0.018).

Conclusions: Despite the complications of fixation with the DHS device, it remains the most successful for treatment of intertrochanteric fractures.
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http://dx.doi.org/10.5812/traumamon.10436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860680PMC
September 2013

The comparison of Ethibond sutures and semitendinosus autograft in the surgical treatment of acromioclavicular dislocation.

Acta Orthop Traumatol Turc 2013 ;47(5):307-10

Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran.

Objective: The aim of this study was to compare the results of the surgical reconstruction of the acromioclavicular joint (ACJ) dislocations using No. 5 Ethibond suture or semitendinosus autograft.

Methods: This analytical cross-sectional study was conducted on the medical records of 39 patients (35 males and 4 females; mean age: 32.6±11.8 years), with complete ACJ joint dislocation (Type 3 to 6). Twenty one patients underwent reconstruction using No. 5 Ethibond suture (Group A) and 18 patients using semitendinosus tendon autograft (Group B). The patients' database records were queried for the information regarding the evaluations during follow-up period (mean: 25.7 months) such as radiographic evaluations, Constant score, VAS score and infection.

Results: The mean Constant score was 91±1 and 92±2.1 in Groups A and B, respectively. There was a reduction of ACJ based on Zanca view in 15 patients in Group A and 12 patients in Group B. There was subluxation of ACJ by less than 25% in six patients in Group A and five in Group B, in that, the difference was not significant. Patients expressed acceptable satisfaction and equal pain severity in rest and daily activity in both groups. No deep infection has been observed.

Conclusion: Since both surgical techniques led to satisfactory results, reduction of ACJ, excellent functional score and acceptable patient satisfaction, No. 5 Ethibond suture technique could be recommended as the treatment of choice due to the absence of morbidity in removing semitendinosus autograft tendon.
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http://dx.doi.org/10.3944/aott.2013.3015DOI Listing
July 2014

Arthroscopic treatment of patients with anterolateral impingement of the ankle with and without chondral lesions.

J Foot Ankle Surg 2013 Mar-Apr;52(2):188-91. Epub 2013 Jan 10.

Orthopedic Department, Guilan University of Medical Sciences, Rasht, Iran.

Anterolateral impingement syndrome is defined as chronic pain in the ankle secondary to soft tissue impingement, hypertrophy, or tearing of the lateral and anterolateral ligaments of the ankle. The purpose of the present study was to evaluate the results of arthroscopic treatment of anterolateral impingement syndrome and its association with chondral lesions. In this case series study, 23 patients with anterolateral impingement syndrome underwent arthroscopic debridement of the ankle. Simple radiography and magnetic resonance imaging were applied for all the patients to diagnose the spur condition and to exclude patients with other possible lesions. All the patients were evaluated preoperatively and at interval visits of 2, 4, and 6 weeks and 3 and 6 months postoperatively according to the American Orthopaedic Foot and Ankle Society criteria and Meislin score. The mean patient age was 38.13 ± 6.85 years. Significant differences were seen between the mean American Orthopaedic Foot and Ankle Society scores, which was 59.21 before surgery and 83.56 and 88.13 at 3 and 6 months postoperatively, respectively. No significant differences were seen between the American Orthopaedic Foot and Ankle Society scores of the patients with or without chondral lesions. Arthroscopic treatment of anterolateral impingement syndrome is recommended as the treatment of choice and is still considerably effective in patients with chondral lesions.
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http://dx.doi.org/10.1053/j.jfas.2012.10.017DOI Listing
August 2013