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Showing 6 results for AFSHARFARD

M Mozaffar, A AFSHARFARD, F Malekpour, R Vaghardoost,
Volume 18, Issue 2 (9-2004)

In this prospective descriptive study, all patients with acute lower limb ischemia who presented to Shohada Tajrish Hospital (STH) between July 200 1 and July 2003 were analyzed and followed for 6 months. The total population of 109 patients, with no significant difference in sexual distribution had a mean age of 64± 16 years. 23% had AF and 31 % had a history of MI, 'but in the ECG of 30%, no pathologic finding had been detected. Pain and coolness were the two most prevalent symptoms. Only onethird of the patients.had normal sensory and motor examination in their limb and the rest had different degrees of impairment. More than 70% of the patients arrived here after 12 hours from the onset of the symptoms. Fasciotomy was done in 29%, and amputation in 23.5%. The mortality rate was 12.2%. Surgical site infection occurred in 11 % and] 4.1 % underwent re-embolectomy. There was no pseudoaneurysms. The time interval from the onset, sensory and motor findings, and calf tenderness affected the prognosis. Prognosis was better in smokers. The iatrogenic group which consisted of 13.7% of our patient population had the best prognosis (no mortality or morbidity). 4% of the patients who had first undergone embolectomy in other centers, all lost their limbs. In cases of late embolectomies, venotomy and heparin flush has lowered the amputation level without increasing mortality. Early referral by a cardiologist, receiving heparin rapidly and smoking are among the factors which improve prognosis.
Mk Motamedi, M Mozaffar, A AFSHARFARD, F Malekpour, R Vaghardoost,
Volume 18, Issue 3 (11-2004)

Embolectomy has long been the gold standard for treating limbs acutely threatened by arterial occlusion. Delayed embolectomy has not been investigated adequately due to the belief that accompanying mortality and morbidity render the case futile. Following our previous experience with late arterial repair for leg or knee salvage I we applied the same principle to limbs threatened with prolonged ischemia as a result of missed emboli. In this study the response of patients with delayed embolectomy in a 2-year interval is evaluated. All of the patients who presented to Shohada Tajrish Medical Center, Tehran, Iran between 2001 to 2003 with prolonged ischemia of the lower limb (more than 12 hours) were selected for this study. All underwent embolectomy and prior to reinstitution of blood to the ischemic leg, all those with calf rigor underwent simultaneous venotomy and irrigation of the arterial tree with heparinized solution and were studied accordingly. Of the total 76 patients 20% had muscle rigor on admission who underwent simultaneous venotomy and irrigation. The limb was salvaged in 45% of patients with above knee sensory deficit and 40% of those with above knee motor deficit. The salvage rates of the limb for below knee sensory and motor deficits were 79% and 85% respectively. We were able to save the knee in 20% of our patients. The short term m011ality rate in the whole was 9.2%. We had only one operative mortality in this high risk group of patients & our figures are lower than those reported in the literature, while at the same time we were able to salvage their limbs or knees.
A AFSHARFARD, M Mozaffar, Ar Fadaee Naeeni, F Aghaee Meybodi, Am Tofigh,
Volume 18, Issue 4 (11-2005)

Regarding the increasing numbers of IV drug addicts, the incidence of infected pseudoaneurysm is increasing. So far, different therapeutic strategies have been tried, but each method has its own drawbacks. Therefore, discovering an appropriate therapeutic method is necessary. 65 patients with infected pseudoaneurysm due to drug injection referred to Shohada Medical Center from Feb 1994 till Oct 2003 were chosen. After obtaining proximal control of the external iliac artery, femoral artery ligation was performed in all patients. The patients were observed for signs and symptoms of ischemia. After primary ligation of the involved artery, acute ischemia occurred in only 6 patients who later underwent extra-anatomical bypass. Only 3 patients underwent amputation. One of them was performed after extra-anatomical bypass and two cases after arterial ligation, as ischemia and gangrene had been present on admission. During patient follow up (minimum 3 months, maximum 3 years and average 12 months), 8 cases of slight claudication (9.3 % ) and 3 cases of severe claudication were reported and the rest have been symptom-free. Various treatments have been used for infected pseudoaneurysm, but none of them are faultless. According to infection of the site and existence of extensive necrosis and inflammatory tissue, anatomical and even non-anatomical bypasses are almost improbable. The results of this study indicate that arterial ligation could be the fIrst and probably the best choice of treatment in such patients with less cost and also without mentionable morbidity or mortality. This procedure must be performed in a vascular surgery center to perform vascular bypass if needed.
M Mozafar, A AFSHARFARD, Am Tofigh,
Volume 19, Issue 1 (5-2005)

Background: The aim of this study is to evaluate the long and short ten postoperative results after the Notaras procedure as a surgical treatment of rectal prolapse in adults. Methods: Thirty-one patients suffering from rectal prolapse who were operated with Notaras posterior mesh rectopexy in Shohada-e-Tajrish hospital between 1991- 2000 were followed up for results and complications and the results were compared with other surgical techniques for this disease. Results: The mortality rate was zero which was ideal in comparison with other studies short ten complications were seen in 20% of cases which had the same prevalence as other abdominal surgeries. Sexual impotence and retrograde ejaculation as long tern1 complications were seen in only one patient (3.22% ).The recurrence rate was zero which stands above nearly all other procedures, also we had recuperation of fecal incontinence in all of our cases and gas incontinence in 92 % of them. The constipation rate has not increased significantly postoperatively (p= 0.8) Conclusion: The Notaras procedure can be used in the management of rectal prolapse with low mortality and recurrence rate but although not contraindicated, may not be appropriate for young and sexually active male patients.
H. Khajouei Kermani, A. AFSHARFARD, M. Zeynalzadeh, A. Najafbeigi, P. Yavari, M. R. Kalantar Motamedi,
Volume 20, Issue 4 (2-2007)


 Background: The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction. On the other hand, there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth.

 Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis, we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.

 Results: There was no significant difference in the rate of wound infection between these two groups.

 Conclusions: This study shows that perfect closure of the wound with subcuticular closure, which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.

A. AFSHARFARD, M . Mozaffar, H. Vafaei, A. Kavyani, A. Saberi, M. Zeinalzadeh, M. Sharifi,
Volume 21, Issue 4 (2-2008)


 Background: There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence.

 Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned.

 Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy 2 had a positive DPL and negative laparotomy 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy.

 Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

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