Background : Special attention to medical education and hospital expense were the main reasons to... more Background : Special attention to medical education and hospital expense were the main reasons to develop a new fee-for service program (CARANEH) in educational hospitals. The main objectives of this program were to improve medical education via encouraging faculty members, and to support the educational hospitals financially. Objective : The objective of this study was to evaluate the opinions of clinical faculty members of Isfahan University of Medical Science about the efficacy of CARANEH program in providing educational services. Methods : In this cross-sectional study, 69 clinical faculty members who were directly involved in medical education and CARANEH program were asked to fill out a questionnaire designed in four domains. Results : According to the results, faculty members did not have enough information about the content of CARANEH program. Moreover, 60% of the respondents believed that CARANEH had not increased attendance of clinical faculty members in their due educational activities. In addition, more than 65% believed that CARANEH had not improved undergraduate and postgraduate education. According to the respondents, major priorities in improving medical education are respectively improving educational facilities in hospital wards (87.5%), libraries (85.2%) and audio-visual section (84.3%) Conclusion : According to these results, it seems that CARANEH program has been an unsuccessful program in improving medical education in educational hospitals. Even though the theoretical concept of CARANEH had been based on improving medical education, but practically the idea has not worked successfully. Therefore, its precise revision can increase its efficacy in this regard. Keywords: Medical education, Fee-for-service payment, Educational Hospital, Faculty members,
Iranian Journal of Nursing and Midwifery Research, Jul 10, 2008
... Page 5. Nurse's stress and environmental - occupational factors Mojdeh et al ... 15. Rez... more ... Page 5. Nurse's stress and environmental - occupational factors Mojdeh et al ... 15. Rezaee Sh. Assessing effect of education of communication skills on nurse's occupational stress that working in reha-bilitation centers in Rey, Tehran and Shemiranat (2003). ...
To evaluate the role of physical examination in decision making for exploring patients with penet... more To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury. This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure. Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration. Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.
Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their m... more Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound). Our results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.
To compare the results of final renal function by two methods of treatment in patients diagnosed ... more To compare the results of final renal function by two methods of treatment in patients diagnosed as posterior urethral valve (PUV) (valve ablation vs. vesicostomy). Fifty-four boys diagnosed with PUV participated in this study. They were divided into top two groups. Thirty-one of the total were treated with primary valve fulguration (Group 1) and 23 were treated with vesicostomy (Group 2). One-year-creatinine level and glomerular filtration rate (GFR) were measured. Also, they were taken ultrasonography detecting hydronephrosis. Data analysed in IBM SPSS21 with t-test and Chi-square test. Presented with 95% of confidence intervals. Fifty-four boys diagnosed with PUV participated in this study. The mean age of patients in Group 1 was 3.8 ± 1.48 days and Group 2 was 4.7 ± 1.85 days. One-year Cr level was 1.57 ± 1.45 in Group 1 and 1.57 ± 1.45 in Group 2 which was not statistically significant (P < 0.8). Also 1-year GFR level was 31.1 ± 4.4 in Group 1 and 33 ± 4.7% in Group 2 (P <...
Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to pre... more Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January–December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas.
Medical science monitor: international medical journal of experimental and clinical research
The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of fa... more The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of families at high risk for premature coronary heart disease (CHD) in comparison to controls, and the degree of agreement between ACLA levels in parents and children. In an analytical case-control study, three paired parent-child groups of 50 each were selected by simple random sampling, and their IgG ACLA levels measured by ELISA method. A comparison was made between parents who had premature myocardial infarction (MI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;55 years of age) and one child aged between 12 to 19 years as the case group, parents with MI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;55 years and one child, and parents with no history of heart attacks and one child as the first and second control groups, respectively. The prevalence of positive ACLA in adolescents in the case group was significantly higher than the second control group (P=0.03), but this difference was not significant against the first control group (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Regarding parents, there were significant differences between the case group and both control groups (P=0.04 and P=0.009, respectively). A substantial degree of correlation was found between positive ACLA in patients with premature MI and their children (kappa correlation coefficient =0.63, 95% CI, 0.47-0.79). The findings of this study point to the probable presence of a familial immunological background in the onset of premature atherosclerosis with regard to ACLA, which can be measured as a risk factor in predicting premature CHD.
To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acut... more To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for age, gender, date and method of treatment in relation to seasons and Ramadan fasting month. For comparison, we used Shaaban months (prior months) and Shavval months (following months). Eight hundred and sixty-four files (32.7% male and 62.8% were female) with definite diagnosis of acute cholecystitis were reviewed. Mean age was 56.3 +/- 16.18 years. The frequency of acute cholecystitis was higher in summer in comparison with other seasons. The difference in the frequency of acute cholecystitis in Ramadan in comparison with Shaaban and Shavval months was not considerable. Acute cholecystitis displays seasonal characteristics; however, this seasonal variability ...
Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the tr... more Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the treatment of choice. There is scarce information regarding the prophylactic effects of oral metronidazole on postoperative complications of anal fissure. The objective of this study was to determine the effects of metronidazole as a prophylactic measure for postoperative anal fissure complications. In
Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association, 2013
Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their m... more Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients reveale...
Medical science monitor : international medical journal of experimental and clinical research, 2003
The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of fa... more The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of families at high risk for premature coronary heart disease (CHD) in comparison to controls, and the degree of agreement between ACLA levels in parents and children. In an analytical case-control study, three paired parent-child groups of 50 each were selected by simple random sampling, and their IgG ACLA levels measured by ELISA method. A comparison was made between parents who had premature myocardial infarction (MI<55 years of age) and one child aged between 12 to 19 years as the case group, parents with MI>55 years and one child, and parents with no history of heart attacks and one child as the first and second control groups, respectively. The prevalence of positive ACLA in adolescents in the case group was significantly higher than the second control group (P=0.03), but this difference was not significant against the first control group (p>0.05). Regarding parents, there were...
To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acut... more To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for age, gender, date and method of treatment in relation to seasons and Ramadan fasting month. For comparison, we used Shaaban months (prior months) and Shavval months (following months). Eight hundred and sixty-four files (32.7% male and 62.8% were female) with definite diagnosis of acute cholecystitis were reviewed. Mean age was 56.3 +/- 16.18 years. The frequency of acute cholecystitis was higher in summer in comparison with other seasons. The difference in the frequency of acute cholecystitis in Ramadan in comparison with Shaaban and Shavval months was not considerable. Acute cholecystitis displays seasonal characteristics; however, this seasonal variability ...
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We compared the efficacy of intra-sphincteric botulinum toxin (BT) injection and posterior anorec... more We compared the efficacy of intra-sphincteric botulinum toxin (BT) injection and posterior anorectal myectomy (PARM) for the treatment of internal anal sphincter achalasia (IASA). Twenty eight of 120 patients (23%) with chronic constipation, who were referred to our clinic from September 2005 to December 2006, were evaluated. Patients had an absence of rectoanal inhibitory reflex on anorectal manometry (ARM) and showed no transitional region on barium enema. Fourteen patients each underwent rectal biopsy, and were treated with either intrasphincteric BT injection (Group I) or PARM (Group II). Nine patients were excluded because of absent ganglion cells on histology or positive acetylcholinesterase staining (AChE). The remaining 19 patients were followed up. All patients underwent ARM and constipation severity score (CSS) assessment 2 weeks before, and 1 and 6 months after the treatment. Patients were followed up telephonically at 12 months after treatment. Clinically good response w...
Background : Special attention to medical education and hospital expense were the main reasons to... more Background : Special attention to medical education and hospital expense were the main reasons to develop a new fee-for service program (CARANEH) in educational hospitals. The main objectives of this program were to improve medical education via encouraging faculty members, and to support the educational hospitals financially. Objective : The objective of this study was to evaluate the opinions of clinical faculty members of Isfahan University of Medical Science about the efficacy of CARANEH program in providing educational services. Methods : In this cross-sectional study, 69 clinical faculty members who were directly involved in medical education and CARANEH program were asked to fill out a questionnaire designed in four domains. Results : According to the results, faculty members did not have enough information about the content of CARANEH program. Moreover, 60% of the respondents believed that CARANEH had not increased attendance of clinical faculty members in their due educational activities. In addition, more than 65% believed that CARANEH had not improved undergraduate and postgraduate education. According to the respondents, major priorities in improving medical education are respectively improving educational facilities in hospital wards (87.5%), libraries (85.2%) and audio-visual section (84.3%) Conclusion : According to these results, it seems that CARANEH program has been an unsuccessful program in improving medical education in educational hospitals. Even though the theoretical concept of CARANEH had been based on improving medical education, but practically the idea has not worked successfully. Therefore, its precise revision can increase its efficacy in this regard. Keywords: Medical education, Fee-for-service payment, Educational Hospital, Faculty members,
Iranian Journal of Nursing and Midwifery Research, Jul 10, 2008
... Page 5. Nurse's stress and environmental - occupational factors Mojdeh et al ... 15. Rez... more ... Page 5. Nurse's stress and environmental - occupational factors Mojdeh et al ... 15. Rezaee Sh. Assessing effect of education of communication skills on nurse's occupational stress that working in reha-bilitation centers in Rey, Tehran and Shemiranat (2003). ...
To evaluate the role of physical examination in decision making for exploring patients with penet... more To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury. This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure. Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration. Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.
Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their m... more Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound). Our results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.
To compare the results of final renal function by two methods of treatment in patients diagnosed ... more To compare the results of final renal function by two methods of treatment in patients diagnosed as posterior urethral valve (PUV) (valve ablation vs. vesicostomy). Fifty-four boys diagnosed with PUV participated in this study. They were divided into top two groups. Thirty-one of the total were treated with primary valve fulguration (Group 1) and 23 were treated with vesicostomy (Group 2). One-year-creatinine level and glomerular filtration rate (GFR) were measured. Also, they were taken ultrasonography detecting hydronephrosis. Data analysed in IBM SPSS21 with t-test and Chi-square test. Presented with 95% of confidence intervals. Fifty-four boys diagnosed with PUV participated in this study. The mean age of patients in Group 1 was 3.8 ± 1.48 days and Group 2 was 4.7 ± 1.85 days. One-year Cr level was 1.57 ± 1.45 in Group 1 and 1.57 ± 1.45 in Group 2 which was not statistically significant (P < 0.8). Also 1-year GFR level was 31.1 ± 4.4 in Group 1 and 33 ± 4.7% in Group 2 (P <...
Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to pre... more Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January–December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas.
Medical science monitor: international medical journal of experimental and clinical research
The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of fa... more The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of families at high risk for premature coronary heart disease (CHD) in comparison to controls, and the degree of agreement between ACLA levels in parents and children. In an analytical case-control study, three paired parent-child groups of 50 each were selected by simple random sampling, and their IgG ACLA levels measured by ELISA method. A comparison was made between parents who had premature myocardial infarction (MI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;55 years of age) and one child aged between 12 to 19 years as the case group, parents with MI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;55 years and one child, and parents with no history of heart attacks and one child as the first and second control groups, respectively. The prevalence of positive ACLA in adolescents in the case group was significantly higher than the second control group (P=0.03), but this difference was not significant against the first control group (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Regarding parents, there were significant differences between the case group and both control groups (P=0.04 and P=0.009, respectively). A substantial degree of correlation was found between positive ACLA in patients with premature MI and their children (kappa correlation coefficient =0.63, 95% CI, 0.47-0.79). The findings of this study point to the probable presence of a familial immunological background in the onset of premature atherosclerosis with regard to ACLA, which can be measured as a risk factor in predicting premature CHD.
To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acut... more To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for age, gender, date and method of treatment in relation to seasons and Ramadan fasting month. For comparison, we used Shaaban months (prior months) and Shavval months (following months). Eight hundred and sixty-four files (32.7% male and 62.8% were female) with definite diagnosis of acute cholecystitis were reviewed. Mean age was 56.3 +/- 16.18 years. The frequency of acute cholecystitis was higher in summer in comparison with other seasons. The difference in the frequency of acute cholecystitis in Ramadan in comparison with Shaaban and Shavval months was not considerable. Acute cholecystitis displays seasonal characteristics; however, this seasonal variability ...
Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the tr... more Chronic anal fissure is one of the most common causes of anal pain and surgical therapy is the treatment of choice. There is scarce information regarding the prophylactic effects of oral metronidazole on postoperative complications of anal fissure. The objective of this study was to determine the effects of metronidazole as a prophylactic measure for postoperative anal fissure complications. In
Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association, 2013
Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their m... more Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz. From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study. The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients reveale...
Medical science monitor : international medical journal of experimental and clinical research, 2003
The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of fa... more The objective of our research was to study anticardiolipin antibody (ACLA) in the offspring of families at high risk for premature coronary heart disease (CHD) in comparison to controls, and the degree of agreement between ACLA levels in parents and children. In an analytical case-control study, three paired parent-child groups of 50 each were selected by simple random sampling, and their IgG ACLA levels measured by ELISA method. A comparison was made between parents who had premature myocardial infarction (MI<55 years of age) and one child aged between 12 to 19 years as the case group, parents with MI>55 years and one child, and parents with no history of heart attacks and one child as the first and second control groups, respectively. The prevalence of positive ACLA in adolescents in the case group was significantly higher than the second control group (P=0.03), but this difference was not significant against the first control group (p>0.05). Regarding parents, there were...
To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acut... more To investigate whether Ramadan fasting and seasonal variation has any effect on the onset of acute cholecystitis. A cross-sectional study was conducted in Faghihi and Namazee Hospitals between September 1999 to August 2004. All files of patients with definite diagnosis of gallstone induced acute cholecystitis were reviewed for age, gender, date and method of treatment in relation to seasons and Ramadan fasting month. For comparison, we used Shaaban months (prior months) and Shavval months (following months). Eight hundred and sixty-four files (32.7% male and 62.8% were female) with definite diagnosis of acute cholecystitis were reviewed. Mean age was 56.3 +/- 16.18 years. The frequency of acute cholecystitis was higher in summer in comparison with other seasons. The difference in the frequency of acute cholecystitis in Ramadan in comparison with Shaaban and Shavval months was not considerable. Acute cholecystitis displays seasonal characteristics; however, this seasonal variability ...
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
We compared the efficacy of intra-sphincteric botulinum toxin (BT) injection and posterior anorec... more We compared the efficacy of intra-sphincteric botulinum toxin (BT) injection and posterior anorectal myectomy (PARM) for the treatment of internal anal sphincter achalasia (IASA). Twenty eight of 120 patients (23%) with chronic constipation, who were referred to our clinic from September 2005 to December 2006, were evaluated. Patients had an absence of rectoanal inhibitory reflex on anorectal manometry (ARM) and showed no transitional region on barium enema. Fourteen patients each underwent rectal biopsy, and were treated with either intrasphincteric BT injection (Group I) or PARM (Group II). Nine patients were excluded because of absent ganglion cells on histology or positive acetylcholinesterase staining (AChE). The remaining 19 patients were followed up. All patients underwent ARM and constipation severity score (CSS) assessment 2 weeks before, and 1 and 6 months after the treatment. Patients were followed up telephonically at 12 months after treatment. Clinically good response w...
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