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Background and Aim: Covid-19 is spreading in the world and the governments are taking further steps to curb the rate of virus infection. An increase in the number of cases of Covid-19 has led to a challenging condition and we have to decide to decrease or stop elective surgeries.
Materials and Methods: Using keywords of elective surgery, emergency surgery, coronavirus, Covid 19, we searched Persian and international databases (SID Magiran, Iranmedex, Google Scholar, Medline, Scopus, Elsevier, Pubmed, Sciencedirect) for the related English or Persian studies. Finally, we selected 31 articles.
Results: All hospitals and surgeons must draw up a plan to limit, postpone or cancel elective scheduled operations, endoscopy, or other invasive procedures until the necessary health care facilities and measures for the patients are available.
 Conclusion: During the current Covid-19 epidemic protection of hospital resources such as hospital beds and ICUs, respirators, and patients and staff is necessary. It is recommended that hospitals stop elective surgeries. Accurate clinical judgment should be considered as the determinative factor in performing operations

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Background and Aim: Breast cancer is the most common malignancy among women in the world. Timely use of appropriate diagnostic methods in the early stages of this cancer can reduce its consequences and mortality.
Materials and Methods: 287 women with breast mass referring to the Breast Cancer Research Center affiliated to Shahid Beheshti University of Medical Sciences, Tehran (Iran) participated in this cross-sectional study. Demographic data, clinical manifestations and drug history were recorded. Clinical examinations were carried out by a qualified physician. Finally, the correspondence between the data obtained from the clinical examinations with the pathologic results was evaluated.
Results: 287 women with breast cancer (age range: 22-84 year old) participated in the study. Mean and standard deviation (SD) of participants’ age was 47.71±11.62. Based on pathology results 64 subjects (22.30%) had benign and 223 (77.70%) had malignant lesions. 37 subjects (12.89%) had benign and 250 (87.11%) had malignant lesions on the basis of the clinical breast examination (CBE). Sensitivity and specificity of CBE were 98.21% and 51.56%, and also, positive predictive value (PPV) and negative predictive value (NPV) were 87.6% and 89.19% respectively. Younger women were less likely to have malignant breast mass compared to older women. Moreover, a significant difference was found between unemployed and employed women as well as between menopausal and non menopausal women.
Conclusion: The results of the present study showed that clinical examination by skilled physicians can still be an important, highly sensitive and reliable method for diagnosis of breast cancer, especially in the patients who had breastfed their infants for more than 24 to 72 months, and menopausal women or patients with more than 3 pregnancies.

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Background and Aim: Controversy exists over the preferred surgical method for inguinal hernia repair between the open and laparoscopic methods. This clinical trial was performed to compare the rate of early complications and recurrence rates of inguinal hernia between laparoscopic (TAPP) and open methods (Lichtenstein).
Material and Methods: In this clinical trial, 84 patients who were candidates for elective inguinal hernia repair at Imam Hossain Hospital were randomly divided into two groups: TAPP and Lichtenstein groups. Spinal anesthesia was used for both groups. Patients were followed for short-term complications (e.g. infection, seroma, hematoma, postoperative pain), hospitalization stays, and recurrence within the first year. Data were analyzed using SPSS software (version 16).
Results: There were no significant differences between the two groups in terms of age and gender. Unfortunately, in the TAPP group, 23 patients (54.8%) received general anesthesia due to lack of co-operation, excessive abdominal wall stiffness, and failure of spinal anesthesia. We found shorter hospitalization stay (P <0.001), less postoperative pain in the first 24 hours (P <0.001), and longer operative time (P <0.001) in the TAPP group compared with those in the Lichtenstein group. There were no significant differences between the two groups in terms of infection and recurrence rates in the first year. Seroma was seen only in 16.7% of the patients in the Lichtenstein group (P <0.012). Pain intensity measured in the first 24 hours at three-time points (1, 8, and 24 hours) was lower in the TAPP group with spinal anesthesia than in the TAPP with GA and Lichtenstein groups (P <0.001).
Conclusion: The results of this study showed that TAPP with spinal anesthesia is associated with reduced postoperative pain in the first 24h, and irrespective of the  type of anesthesia TAPP is associated with lower risk of seroma formation

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Background and Aim: Obesity increases risk of venous thromboembolism due to increase in coagulation factors. Screening for deep vein thrombosis (DVT) before bariatric surgery can minimize the incidence of venous thromboembolism (VTE) in these patients. This study aimed to determine the importance of color Doppler ultrasound before bariatric surgery to detect subclinical deep vein thrombosis in the patients.
Materials and Methods: This was a descriptive cohort study. The study population included candidates for bariatric surgery admitted to Modares and Loghman hospitals in Tehran (a bariatric surgery center in Iran) between March-20 and September-20, 2021. Patients were followed up for 30 days after surgery. Census sampling was used. Data were finally entered into SPSS-23 statistical software and analyzed by descriptive tests.
Results: Among 125 patients in this study, 85 (64%) were woman. The patient’s mean and standard deviation of age and Body Mass Index were 33.68 ± 6.8 and 43.15 ± 4.9, respectively. Before surgery, all patients were evaluated for subclinical DVT and the results of the study showed that none of the patients had any evidence in favor of DVT. After the surgery, the patients underwent regular follow-ups for a month, but no positive cases of deep vein thrombosis were reported.
Conclusion: In our study thromboembolic problems were rare in patients before obesity surgery. Therefore, routine ultrasound examination before surgery does not seem reasonable.
 

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Background and Aim: Primary hyperparathyroidism leads to increased secretion of parathyroid hormone and hypercalcemia. Parathyroid lesions are often in the form of adenoma, hyperplasia, and carcinoma. The aim of this study was to investigate clinical manifestations, pathological findings, and the response to the treatment in the patients with parathyroidectomy.
Materials and Methods: In this cross-sectional-analytical study (2002-2017),we extracted data from 37 records  of the patients who had undergone parathyroidectomy in the hospitals associated with Babol University of Medical Sciences. The data were about age, gender, pre-and post-operative values of laboratory indices, pathology of the lesions, and the surgical procedure. Using SPSS- 20 software, data were analyzed by, descriptive statistics, Fisher's exact and Wilcoxon's statistical tests (P<0.05).
Results: The majority of patients were female (67.57 %) and the mean age was 47.13 ± 15.27 years. The disease with skeletal manifestations was more common (45.28%). Adenoma was the most common type of lesion in radiology (78.37 %) and pathology (63.41 %) and the predominant surgical method was unilateral exploration (64.86%). A statistically significant relationship was observed between the type of pathological lesion and the patient's age grou (p=0.037) and gender(p = 0.013). The success of parathyroidectomy surgery was evaluated as significant based on the pre- and post-operative values of calcium (P<0.001) and parathormone (P<0.001).
Conclusions: Primary hyperparathyroidism disease in Iran is a symptomatic disorder that most frequently manifests with bone symptoms, and parathyroidectomy surgery is the definitive treatment method. Improvement of bone symptoms, measurement of calcium, and parathormone can be considered indicators of improvement in these patients.

 

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Background and Objective: Hemorrhoids are known as one of the most common anorectal diseases and the most common cause of lower gastrointestinal bleeding. Investigating which type of technique and approach the surgeon has more expertise during hemorrhoidectomy surgery and the patient faces fewer complications is crucial. Therefore, this study evaluated the effects of the Jackknife and Lithotomy positions on the course and complications of hemorrhoidectomy surgery.
Materials and Methods: The present study was a clinical trial conducted on 60 patients with hemorrhoids at Besat Hospital in Hamedan. The patients were randomly divided into two groups of 30. The first group underwent surgery using the Jackknife position, while the second group underwent the conventional method using the Lithotomy position. Finally, variables such as the amount of bleeding, duration of surgery, surgeon's field of view, local posture discomfort, and postoperative pain were analyzed and compared between the two groups using SPSS software version 24.
Results: 22 (36.7%) of the patients were male and 38 (63.3%) were female. According to the findings, the duration of surgery and the amount of bleeding were less in the group undergoing surgery with the jackknife position, and a significant difference was observed between the surgical position and these two variables (p-value<0.001). Also, based on the chi-square test, there was a statistically significant relationship between the surgical position and the surgeon's satisfaction with the angle of view, so a better field of view was reported in the jackknife position (exact p-value = 0.001). In this study, no significant difference was observed between the surgical position and the level of local posture discomfort of the surgeon and between the surgical position and the postoperative pain complication (significance level 0.091 and 0.66, respectively).
Conclusions: Performing hemorrhoidectomy surgery with the Jackknife position compared to the Lithotomy position can reduce the amount of bleeding in patients, shorten the duration of surgery, and provide a better field of view and exposure for the surgeon. Additionally, based on the findings, using either position does not significantly impact the level of local discomfort or postoperative pain.



 

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Background and Aim: Thyroid nodules are among common clinical problems and fine needle aspiration (FNA) sampling is the most important method to diagnose its pathological nature. The frozen section (FS) is also very important in making treatment decisions. The present study was conducted to compare the diagnostic value of these two methods based on pathology findings in the patients with thyroid nodules.
Materials and Methods: This descriptive-analytical study included patients with thyroid nodule surgery between 2011 and 2019 in Babol City. Information was collected by file reading method. Data analysis was done using SPSS-26 software and a comparative survey of the diagnostic value of pathology methods, FNA biopsy, and FS examination, was performed by calculating the sensitivity, specificity, and positive and negative predictive value (p<0.05).
Results: The majority of patients in this study were female (68.66%) and the patients did not have any family history (70.44%). In the final pathology findings, the rates of benign and malignant lesions were; 54.88% and 45.11%, and in FNA and FS, they were 67% and 88.57%, respectively. Sensitivity, specificity, positive and negative predictive values in FNA were; 0.9582, 0.9896, 0.9950, and 0.9697, respectively. Sensitivity, specificity, positive and negative predictive value in FS were 100%. The two mentioned methods were consistent in 58.8% of the cases in the diagnosis of malignant or benign thyroid nodules (p<0.001).
Conclusions: FNA is a reliable method for detecting malignancy in thyroid nodules due to its high sensitivity and specificity. On the other hand, the FS is considered a precise method due to its high correlation with pathology.

 

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Background and Aim: Common methods used in thyroidectomy include total thyroidectomy, subtotal thyroidectomy, and lobectomy. Due to higher treatment costs and lower quality of life of the patients suffering from complications of thyroidectomy, development of new surgical methods is nesessary.
Materials and Methods: In this cohort study, 64 patients underwent thyroid surgery. The clinical information of the patients including pathology report, thyroid volume, TSH level, duration of operation, amount of bleeding during and after operation, duration of hospitalization, hematoma, wound infection, hypocalcemia and recurrent laryngeal nerve damage and Horner syndrome, were collected based on the review of the medical records, follow- up of the patients, the type of surgery (lobectomy and ismectomy, subtotal thyroidectomy and total thyroidectomy) and the complications and factors related to them, after one month of follow-up were investigated.
Results: The results showed that the mean age of the patients was 42.17 year and 54 (84.4%) of them were women. The average intraoperative and postoperative bleeding were 31.09 and 12.81cc respectively. Intraoperative bleeding in the patients with subtotal thyroidectomy surgery was higher than those in the other two methods and showed a significant relationship (P=0.008) but there was no statistically significant difference in the postoperative bleeding among the three surgical methods (P=0.552). The operation time was slightly higher in the total thyroidectomy method but did not show a significant difference (P=0.058) among the three methods.
Conclusion: The results of this study showed that intraoperative bleeding in the patients with subtotal thyroidectomy was higher than those in the other two methods, and no difference was observed in the amount of postoperative bleeding in the three surgical methods. The operation time was slightly higher in the total thyroidectomy method. In this study, surgical procedures were performed by the final year surgical residents with full supervision and the help of experienced specialists. The incidence of complications was closely related to these factors.
 

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Background and Aim: Inguinal hernia repair is performed in two ways, one without mesh and the other with mesh. Use of antibiotics is one of the major challenges in hernia mesh repair. The aim of this study was to investigate the effects of using and not using antibiotics on the infection of the site of operation.
Materials and Methods: This prospective double-blind cohort study performed in Kosar Hospital in Sanandaj. Patients were placed in three groups and examined for postoperative infection at the surgical site. Group A received no antibiotics, group B received preoperative antibiotics and group C received postoperative antibiotics.
Results: Among 186 patients, 56 were in group A, 62 in group B and 68 in group C. A total of 8 patients (4.3 percent) in 3 groups developed complications, which included erythema and discharge from the operation site. In group A, two patients and in group C, 6 patients developed surgical site infection, which showed no significant difference among the three groups (P = 0.317). There was no significant relationship between the incidence of the complications (R = 135, Adj.R2 = 0.007, P = 0.187) and age, residential place and site of operation.
Conclusions: Based on the results of our study, antibiotics are not necessary in the patients undergoing inguinal hernia surgery with mesh. Therefore, routine antibiotic use should not be advocated. This viewpoint is very effective in reducing antibiotic resistance.
 

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Background and Aim: Lungs are the main organs of respiration in the body, whose main function is the ventilation of respiratory air. Through oxygenation, the lungs convert venous blood into arterial blood so that oxygen is available to the cells as the main molecule of the metabolic cycle in the body (production of Adenosine Triphosphate (ATP)). In a healthy and normal person, the lungs occupy the lateral parts of the chest cavity.
Case Presentation: During the dissection of the lungs, it was found that the posterior border of the right lung does not have a normal morphology. The posterior border of the right lung had a heart incisura, similar to which does not exist in normal conditions. Also, the left lung and its external surface had an accessory fissure and lacked normal structure. These conditions cause abnormal and unexpected divisions of pulmonary segments, which lack knowledge, cause diagnostic and surgical errors.
Conclusion: Knowing the variation in the anatomical structure of the lungs is particularly important in the diagnosis and treatment of respiratory diseases. The existence of this report and its help in understanding the types of anatomical diversity of the lungs will lead to a greater understanding of the morphological diversity of the lungs in the field of diagnosis in radiology images, CT scan, magnetic resonance imaging (MRI), differentiation of pulmonary pathology, and segmental reconstructive surgeries. 
 

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Background & Objective: Laparoscopic cholecystectomy is used as a standard method for gallbladder resection due to less pain and bleeding than open surgery. This study was performed to evaluate and compare the severity of pain after laparoscopic cholecystectomy with the intra peritoneal injection of bupivacaine or hydrocortisone alone or bupivacaine with morphine in 5th Azar educational hospital in Gorgan in 2015.
Materials & Methods: This randomized double-blind clinical trial study was performed on 60 patients undergoing laparoscopic cholecystectomy surgery. Patients divided into 3 groups: A (30 cc of bupivacaine 0.25% intra peritoneal) B (30 cc of bupivacaine 0.25% with 2 mg morphine intraperitoneal) and C (200 mg hydrocortisone at 30 cc). The severity of pain, hemodynamic parameters is registered in specific times (at 30 minutes, 1, 4 hours after surgery. Data were analyzed  by ANOVA,independent T test  and chi-square in SPSS 18 software.
Results: Postoperative pain intensity was significantly higher in group C than the other two groups (P <0.05). Group A showed less pain intensity only in the first half-hour after surgery than group B but in 1 and 4 hours after surgery, pain intensity was less reported in group B.
Conclusion: it seems that the combination of bupivacaine and morphine in 1 to 4 hours after surgery has a better effect on reducing pain in patients after laparoscopic cholecystectomy.