Background: Spinal anesthesia is the most commonly used method for elective cesarean section, which is a popular technique due to its simplicity, reliability, and speed to achieve adequate anesthesia. Headache following dura perforation is the most important delayed complication following spinal and epidural anesthesia. Objectives: To evaluate the impact of low-dose intravenous ketamine in patients undergoing cesarean section under spinal anesthesia on the prevention of dura perforation headache (PDPH). Methods: This clinical trial study was performed on 64 pregnant women undergoing cesarean section at Vali-e-Asr Hospital. The patients were divided into two groups. In the case group, 0.15 mg/kg body weight ketamine was injected intravenously and in the control group, normal saline was used as the placebo. The incidence of headache and its severity at one, 4, 12, and 24 hours postoperatively, nausea and its severity were also measured and compared. Independent t-test, Mann-Whitney U and chi-square tests were used. A P value < 0.05 was considered statistically significant. Results: The data revealed that low dose intravenous ketamine significantly decreased patients' headaches (P = 0.001), the sensation of pruritus (P = 0.009), and the need for analgesic (P = 0.001). Furthermore, the sensation of postoperative nausea was less in the case group. The patients in the case and control groups had no significant difference in terms of hypertension or bradycardia (P = 0.717 and 0.939, respectively). Conclusions: The injection of ketamine as a premedication in the cesarean section can reduce the severity of postoperative headache in mothers. Therefore, it is recommended to use ketamine as an anti-headache drug in pregnant women.
Introduction: Minimal change disease (MCD) is one of the most common diseases affecting glomeruli and causing nephrotic syndrome in both adults and children. Objectives: The aim of this study was to evaluate the degree of accordance between light, fluorescent, and electron microscopies in the diagnosis of MCD. Patients and Methods: In this cross-sectional study, we investigated kidney biopsies which were sent to the referral electron microscopy unit (affiliated to Shiraz University of Medical Sciences) from 2001 to 2016. The final diagnosis of MCD was based on the electron microscopy (EM) study. For each patient, the primary light microscopy (LM) finding was compared with EM diagnosis. The available patients’ demographic, clinical, and paraclinical data were extracted. All the statistical analysis was performed in SPSS 19.0 and P<0.05 was considered as statistically significant. Results: Among all 2865 kidney biopsies, the data of 143 (5.0%) patients with approved MCD by EM were analyzed. The mean age of patients was 23.1± 17.4 years since most of them were male (54.9%). Normal blood urea nitrogen (BUN) and creatinine were observed in 76.6% and 78.6% of them respectively. Around, 140 (97.9%) of patients had no tubular atrophy and interstitial fibrosis. The role of EM in the diagnosis of MCD for 61 (50.0%) of cases were essential, for 61 (50.0%) cases were helpful while there was no case with the role of non-necessary. The immunofluorescence (IF) study was performed for 99 (69.2%) patients. Among them, it was negative for 60 (60.6%) of cases and was positive for IgM and C3 in 19 (19.2%) and 11 (11.1%) of cases respectively. The proportion of flank pain was significantly higher among adults. Conclusion: The importance of EM for the diagnosis of MCD is indispensable and undeniable; while LM is not capable of independently leading to a certain diagnosis of MCD. Considering the limitations of using EM, the results obtained from this study can help with the appropriate use of electron microscopy and help physicians to reach earlier diagnosed.
Background: The useful surgical hemostasis agent using in patients with grade 4 of the liver laceration is a challenging problem. This study assessed a topical hemostatic agent (Surgicel) using a partial hepatic laceration hemorrhage model. This experimental study compared the hemostatic effects of Surgicel and conventional gauze packing in hepatic parenchymal bleedings.
Thyroglossal duct cyst carcinoma is uncommon. Its prevalence is less than one percent. Papillary carcinoma is the most common pathologic finding of the thyroglossal duct cyst carcinoma. Metastasis of the cervical lymph node is less common. Its prevalence is less than 8%. A 38-year-old woman presented with a complaint of painless mass in the midline of the neck. Ultrasonography of the neck revealed a solid cystic mass, measuring 5.5 × 2.5 cm in the submental area. Ultrasonography of the neck additionally revealed suspicion lymph node at bilateral level Ib. A preoperative Computed Tomography (CT) showed a 4 cm size MIX heterogeneous lesion in the anterior left-sided hyoid bone. The patient underwent sistrunk surgery, which was the result of the patient’s frozen section papillary carcinoma arising from the thyroglossal duct cyst. The patient had local metastasis to the neck, so she underwent total thyroidectomy and central N-D surgery and bilateral modified radical N-D. Diagnosis of thyroglossal duct cyst carcinoma before surgery is unusual. The definitive diagnosis is often after surgery and is based on the patient’s histopathological findings. The best surgical procedure is sistrunk. But if the patient has local metastasis to the neck, total thyroidectomy and modified radical N-D are performed.
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