ALTERNATIVE THERAPEUTIC APPROACHES FOR PARALYTIC ILEUS IN PERSIAN MEDICINE

Background: Intestinal obstruction is one of the most common causes of acute abdomen and often requires surgical intervention. However, pre-operative and per-operative diagnosis often do not correlate with postoperative histopathology done in suspected cases. Therefore, the study was designed to identify the etiology of intestinal obstruction correlating to pre-operative and per-operative findings with postoperative histopathological findings in suspected cases. Methods: A cross sectional study was conducted at the department of General Surgery, Mymensingh Medical College & Hospital, Mymensingh for 18 months following ethical approval from Institutional Review Board (IRB) of Mymensingh Medical College. During the study period, all patients with suspected intestinal obstruction admitted in Department of Surgery were included based on selection criteria. Total 103 patients were assessed in pre-operative and per-operatively. Histopathological examination was done in suspected cases where diagnosis could not be confirmed without histopathology. Data collection was done with a data collection form. After collection of all the required data, final analysis was carried out by using the SPSS version 21.0. Results: Among 103 cases of intestinal obstruction, mean age was 45.50±14.37 SD (years) with male female ratio-1.78:1. About 66% came from rural areas and 34% were from urban areas. Abdominal pain was the commonest symptom present among the cases which was observed in 91.3% cases. Others common symptoms were vomiting, abdominal distension absolute and relative constipation in 72.8%, 69.9%, 12.6% and 63.1% cases respectively, while abdominal tenderness was the commonest sign present in all cases. Among study population, 68.9% was small bowel obstruction and 31.1% was obstruction in large bowel. According to per-operative findings 22.3% cases were suspected as malignant. Finally 24.3% cases were proved as malignant in subsequent histopathological examination and 75.7% cases

The clinical presentation, management and outcome of patients with small intestinal and large bowel obstruction unrelated to adhesive or primary colonic neoplastic disease is not well described. The aim of this study was to determine the clinical presentation, evaluation, operative management, and outcome in patients with secondary causes of intestinal obstruction. The medical records of 200 patients who underwent an operation for intestinal obstruction from January 1995 through December 1997 were reviewed. Seventy-three patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women with a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's disease (14%), herniae (11%), diverticular disease (7%), and miscellaneous causes (31%). Six patients (8%) had intestinal motor disorders and a misdiagnosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhesive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy. Operative mortality and morbidity were 3 per cent and 48 per cent, respectively, and 15 per cent of patients required reoperation. Suspected intestinal obstruction from secondary causes requires rigorous preoperative evaluation with liberal use of intestinal contrast examinations to avoid misdiagnosis, operative complications, and reoperations.

Intestinal obstruction is among the most prevalent surgical challenges, which impacts millions of individuals and contributes significantly to morbidity and mortality. Objectives: To investigate the age-specific causes and post-operative complications in patients with intestinal obstruction. Methods: All patients who were clinically diagnosed with intestinal obstruction and subsequently underwent surgical intervention were enrolled in this prospective study. Participants were categorized into four age groups. Patients found to have peritonitis without evidence of obstruction during laparotomy were excluded. Operative and histopathological findings were documented, and the data were summarized using frequencies and percentages. Results: The study included 305 patients, 146 males (47.9%) and 159 females (52.1%). The most common causes of intestinal obstruction in group A were tuberculosis (n=32, 35.2%), and adhesions (n=22, 33.3%) were a common etiological factor in group B; malignancies predominated in the elderly. The incidence of post-operative complications was 7.21%. Conclusions: It was concluded that the etiology of intestinal obstruction in adults varies significantly with age, necessitating age-specific diagnostic and therapeutic approaches.

A clinical study of acute intestinal obstruction : Meyer, Karl A. and Brams, William A.Illinois M. J., Jan., 1927, li, 43

Dear Editor, Cancer prevention and treatment is one of the worldwide research priorities. Ancient medicine like Greek, Egyptian, Indian, Chinese and Persian medicine (PM) is a good source for research in intricate field of medicine. According to PM, risk of cancer or being susceptible to it, depends on various factors such as sleep pattern, physical activity, digestive system function, stresses due to personal or social conditions, previous infections, chronic irritation, and inflammation (1, 2). Persian physicians, in more than thousand years ago, had been emphasized the importance of lifestyle on the cancer development and progression. They believed that avoiding from less and late night sleep, mental and emotional excitement such as fear, anger and strenuous exercise can protect patient from progression of cancer (1, 2). Nowadays the influences of some factors were proved and well known (3, 4). Thus, paying attention to other factors which are ignored without sufficient notice is extremely essential and taste of foods is one of them. The type of diet is one of the important factors in prevention for susceptible people and treatment of patient. Persian physicians believed that taste of foods is a significant sign in identification of material effect. Bitter, salty, sour and spicy tastes, in persistent intake, are stimulating factors for cancer progression as a result of liver dysfunction and cancerous material production (1, 2). In the other hand the collective influence of multiple factors is notable. For example, the effects of persistent intake of bitter, sour, salty and spicy tastes are higher in people with excessive anger, poor sleep or constipation disease (1, 2). Recent studies indicate that salty or spicy diet was directly associated with risk of gastric and colorectal cancer in prospective population studies. Consumption of salted meat, pickled and preserved vegetables, are also positively associated with these cancers (5-7). Also a strong adverse effect of total salt intake and salt-rich foods on the risk of stomach cancer has been detected in comprehensive meta-analysis of longitudinal studies in the general population. Epidemiological, clinical and experimental evidence were shown that reduction in population salt intake decreased the rate of gastric cancer (8). According to the PM, these tastes not only are effective in digestive cancer but also can influence the other site of body like breast, uterine, skin and other parts (1, 2). In the other hand, PM recommended tasteless food for cancer patient such as vegetable without taste like cucurbit, barley soup, chicken, goat and lamb meat, fresh fish, fresh milk, wheat bread and sweet almond oil. patients also be avoided from foods such as brassica oleracea (Cabbage, Cauliflower, Kohlrabi) in row form, Solanum melongena (eggplant), Lens culinaris (Lentil), processed meat, salty, sour and spicy taste such as crude onions and garlic, old cheese, salting meat and pepper (1, 2). Although such recent studies expressed that some of these foods like brassica oleracea have anticancer effect in vitro (9, 10) but according to PM viewpoints, in some conditions, these foods can stimulate tumor progression in cancer patients. Thus more in vivo and clinical studies are needed for nutritional advices.

Background Traditional Persian Medicine (TPM) is an ancient medical system that provides suggestions to improve the health of mothers and children during pregnancy and labor. Persian physicians believed that these instructions made labor easier, safer, and less painful. Methods The present randomized clinical trial was conducted among women at 33–38 weeks of pregnancy in Tehran, Iran. TPM instructions consisted of diet, bathing, and application of oil from the 38th week of pregnancy to the onset of labor. The primary outcome was the duration of the active phase of labor. Results The mean duration of the active phase was 331.60 ± 151.48 min for the intervention group and 344.40 ± 271.46 min for the control groups, but it was not statistically significant. The active phase was significantly shorter in women who had better compliance (p=0.03). The need for oxytocin augmentation was 53.3% in the control group and 38.5% in the intervention group (p=0.17). The rate of perineal infection was 13% in the control group and 0% in the intervention group (p=0.11). Conclusions The active phase was not different in the intervention and control groups, but it was shorter in compliant women. It is possible that prolonged use of these recommendations in combination with a sitz baths and a larger sample size could result in more significant outcomes.

Methods of surgical intervention in acute intestinal obstruction with necrosis of the strangulated area of the intestine are the subject of ongoing discussions. There is no doubt that every patient with this disease should undergo emergency surgery. However, diagnosing necrosis of the strangulated area is not easy. For this reason, a number of authors recommend refraining from emergency surgery for all patients with intestinal obstruction during dynamic follow-up, which can last up to 14 days. Over the past century, the etiology of intestinal obstruction has shifted from strangulated hernia to postoperative adhesive disease, which has led to a paradigm shift in methodological approaches. In order to successfully manage acute intestinal obstruction with suspected strangulation, the clinician today must be able to distinguish between patients requiring urgent surgery and those who should receive conservative therapy.In this paper, we consider the surgical approach of delayed anastomosis formation on significant clinical material, including tactical approaches, timing and necessary conditions for anastomosis formation in patients with intestinal obstruction complicated by necrosis of the strangulated area.The complex of therapeutic measures in the treatment of patients with acute intestinal obstruction complicated by necrosis of the strangulated area of the intestine, intraoperative perforation of the intestine during separation of adhesions, both in conditions of peritonitis and without it, should include obstructive resection of the intestine in combination with the formation of an anastomosis in a delayed order, as well as or planned sanitation of the abdominal cavity. All this makes it possible to reduce the incidence of interintestinal anastomosis failure from 86.7 to 0.96% of cases, and postoperative mortality from 41.8 to 14.4%.

We aimed to analyze the computed tomography (CT) imaging signs of bowel wall ischemia in patients with acute intestinal obstruction and construct an imaging prediction model to guide clinical treatment. The CT imaging signs of patients with acute intestinal obstruction diagnosed in our center in recent 6 years were collected for retrospective analysis. The etiology of intestinal obstruction and incidence rate of bowel wall ischemia were recorded, and the specific CT findings of bowel wall ischemia, including mesenteric edema, bowel wall thickening, and fish tooth sign, were analyzed. Among the 302 patients selected, 130 surgically treated patients were eligible for analysis. Bowel wall ischemia in acute intestinal obstruction showed an incidence rate of 14.90%, and the incidence rates of bowel wall ischemia in intra-abdominal hernia, intussusception, incarcerated external abdominal hernia, and volvulus were about 92.30%, 50%, 35.71%, 33.33%, and 12.59%, respectively. The incidence rate of bowel wall ischemia in simple adhesive intestinal obstruction was about 12.59%, and that in malignancy-induced intestinal obstruction was about 6.56%. Univariate analysis revealed 5 factors with statistical significance, including bowel wall thickening, mesenteric edema, bowel wall pneumatosis, ascites, and fish tooth sign. Multivariate logistic regression analysis indicated that fish tooth sign, bowel wall thickening, and mesenteric edema were able to predict bowel wall ischemia, and the corresponding partial regression coefficients were 2.164, 1.129, and 1.173, odds ratios (ORs) were 8.707, 3.093, and 3.232, sensitivity was 0.356, 0.400, and 0.844, and specificity was 0.859, 0.835, and 0.529, respectively. Imaging signs of bowel wall thickening, mesenteric edema, and fish tooth sign are valuable in predicting bowel wall ischemia, among which bowel wall thickening and mesenteric edema have relatively high specificity and fish tooth sign has a relatively high sensitivity. Furthermore, a fish tooth sign has the most favorable predictive value for bowel wall ischemia in acute intestinal obstruction, followed by bowel wall thickening and mesenteric edema.

A 38-year-old woman developed small bowel obstruction shortly after a cholecystectomy because of a massively enlarged leiomyomatous uterus. Small bowel obstruction is a relatively rare complication from fibroid tumors and results from entrapment of the bowel between serosal pedunculated fibroids (as in this patient), adhesions to infarcted leiomyomas, or from compression of the small bowel by the large mass. Large uterine leiomyomas clearly must be considered in the etiology of intestinal obstruction.

Inflammatory fibroid polyps (IFP) are rare benign lesions of the gastrointestinal tract that can lead to serious complications, such as intussusception, particularly in adults. We present a case of small bowel intussusception caused by IFP, emphasizing diagnostic and therapeutic challenges. The patient presented with acute abdominal pain and signs of intestinal obstruction, confirmed by computed tomography, with the tumor identified during transoperatory and histopathological examinations confirmed the diagnosis of IFP. This case highlights the importance of considering IFP as a differential diagnosis in adult bowel obstruction secondary to intussusception, and the need for timely surgical intervention to prevent complications. The literature contains some case reports of IFPs that explaining the management and diagnosis of this pathology. Our objective was to communicate our experience of IFP as the etiology of intestinal obstruction in an elderly adult.

Mechanical bowel obstruction is a frequently encountered surgical emergency and continues to remain a challenge to surgeons despite advances in eld of medicine, pathophysiology, surgical technique and conservative management. This retrospective study in patients operated for acute mechanical bowel obstruction in our department, was intended to highlight the common causes of intestinal obstruction in this geographical location of the study which had suggested measures for treatment of the condition. 50 patients who underwent exploratory laparotomy for intestinal obstruction were compared in terms of age, sex, symptoms, etiology of intestinal obstruction, site of obstruction, operative procedure performed and post operative complications.

Paraduodenal hernia, the most common type of internal herniation, is rare in the etiology of intestinal obstruction. Delayed diagnosis and surgical intervention may result in significant morbidity and mortality risk. This report presents a case of left paraduodenal hernia resulting in acute intestinal obstruction. A 43-year old male patient was admitted with a diagnosis of acute intestinal obstruction. A left paraduodenal hernia was identified by computed tomography findings of an encapsulated cluster of dilated small bowel loops occupying the left upper quadrant between the stomach and pancreas, and the presence of an engorged and displaced vascular pedicle at the orifice of the hernia. Upon further investigation, the dilated proximal jejunal segments were found in the left paraduodenal fossa, enclosed in a hernia sac. After reducing the intestinal segments to the abdominal cavity, the orifice of the hernia sac was closed by suturing to the retroperitoneum. Paraduodenal hernia should be considered as a possible etiology in cases of acute intestinal obstruction with unremarkable presentations. Physicians should be familiar with the demonstrative imaging findings of computed tomography of a paraduodenal hernia. Early surgical intervention is critical to prevent the significant morbidity and mortality associated with this condition.

Objective To evaluate the clinical value of computed tomography (CT) examination in the etiologic diagnosis of small bowel obstruction. Methods From January 2010 to September 2013, a total of 237 patients with small bowel obstruction confirmed by operation were enrolled. The clinical data of all patients were collected. The diagnostic value of color Doppler ultrasound and abdominal CT examination were compared in estimating site of obstruction, etiology of obstruction and strangulation obstruction. Chi square test was performed for count data comparison. Results Among 237 patients with small bowel obstruction, there were 121 patients with data of both color Doppler ultrasound and abdominal CT examination. After operation, it was comfirmed that the accurate diagnosis rates of abdominal CT scan in the site of obstruction, the etiology of obstruction and strangulation obstruction were 75.2% (91/121), 66.1% (80/121) and 87.2% (41/47), respectively, and which were higher than those of abdominal color ultrasound (44.6%, 54/121; 30.6%, 37/121 and 42.6%, 20/47). The differences were statistically significant (χ2=23.555, 30.595 and 20.593, all P<0.01). Conclusion The accurate diagnosis rates of abdominal CT scan in estimating the site of obstruction, the etiology of obstruction and strangulation obstruction were higher than those of color Doppler ultrasound, especially with obvious advantage in judging the etiology of obstruction. Key words: Small bowel obstruction; Diagnosis; Clinical study

Background To compare sensitivity of unenhanced computed tomography (CT) and contrast-enhanced CT for the identification of the etiology of bowel obstruction. Materials and Methods We retrospectively evaluated abdominal CT scans of patients operated for bowel obstruction from March 2013 to October 2017. Two radiologists evaluated CT scans before and after contrast agent in two reading sessions. Then, we calculated sensitivity of CT in the diagnosis of bowel obstruction and determined in which cases the etiology of bowel obstruction was detected on both unenhanced and enhanced CT or on enhanced CT only. The reference standard was defined as the final diagnosis obtained after surgery. Results Eighteen patients (mean age 72 ± 15 years, age range 37-88 years) were included in the study. Sensitivity of unenhanced CT and enhanced CT was not significantly different in either small bowel obstruction (64%, 7/11 patients vs. 73%, 8/11 patients; P = 0.6547) or large bowel obstruction (71%, 5/7 patients vs. 100%, 7/7 patients; P = 0.1410). Adhesions were identified on unenhanced CT as the etiology of small bowel obstruction in 80% (4/5) of patients. Tumors were identified on unenhanced CT as the etiology of large bowel obstruction in 67% (4/6) of patients. Conclusion In the diagnosis of small bowel obstruction due to adhesions with normal bowel wall thickening and when a neoplasm is identified as the etiology of large bowel obstruction on unenhanced CT, an intravenous contrast agent may be avoided for the identification of the etiology. In remaining cases, contrast agent is still recommended.

Background: The term “Hefz al-Sehheh” (Maintaining Health) in traditional Persian medicine has roots in six core principles and is based on the concept that maintaining health is prioritized over treatment. In this day and age of significant advancements in medical technology and therapeutics, less emphasis is being placed on maintaining health and preventing illness. This manuscript presents the viewpoints of prominent figures of medieval Persian medicine on maintaining eye health and preventing diseases. Methods: We reviewed the content of six medieval medical reference books written by six most prominent medieval Persian (Iranian) physicians and polymaths, i.e., Rhazes, Haly Abbas, Avicenna, Jorjani, Aghili Shirazi, and Al-Kahhal. Also, related articles were extracted from valid databases using keywords based on entry and exit criteria without time limits. Results: According to these prominent medieval Persian physicians and polymaths, exposure to extremely hot or cold weather or dusty air; chronic oversleeping or sleep deprivation; sleeping prone on a full stomach; excessive consumption of salty, spicy, sweet, or steamy food; and drinking cold, salted, carbonated water are harmful to eye health. They recommended purging the bowel with laxatives, eating easy-to-digest foods, practicing well-balanced exercise, and avoiding strenuous physical activity and rapid eye movements. Furthermore, they believed that the accumulation of waste products in the body is detrimental to eye health and that therapeutic bloodletting, leeching, rheuming, kohl, and catharsis with laxative drugs are highly effective for maintaining eye health. Moreover, they believed that a person's mental state, i.e., anger, sorrow, grief, joy, and happiness, would influence one's eye health. Conclusion: The emphasis of medieval, traditional Persian medicine on maintaining eye health deserves our attention, realization, and appreciation of the environmental and lifestyle factors that can affect our eyes and other organs' health and well-being.