Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Evaluation of the Safety of Low-Dose Topical Imiquimod Cream on Frontal Sinus Ostium Stenosis Following Endoscopic Sinus Surgery: A Pilot Clinical Trial
Get PDFIntroduction: Frontal sinus ostium stenosis is a common postoperative challenge in endoscopic sinus surgery, potentially leading to disease recurrence. Imiquimod is an immunomodulatory agent with anti-inflammatory and antifibrotic properties, recently gaining attention in experimental studies.Objective: To evaluate the safety of low-dose topical imiquimod cream in reducing the rate of frontal sinus ostium stenosis following endoscopic sinus surgery.Methods: This pilot randomized intra-patient controlled clinical trial was conducted on 20 patients with CRSwNP. Each patient underwent bilateral Draf 2a surgery. One frontal sinus was randomly assigned to receive Gelfoam impregnated with 5% imiquimod cream, with applications repeated in the second and fourth postoperative weeks. The contralateral side served as the control. Patients were assessed at week 4 and month 3 postoperatively via endoscopic and CT imaging. Endoscopic scores were based on the DIP system, and the STDR ratio was evaluated using 3D CT reconstruction. Data analysis was performed using paired t-tests and Wilcoxon tests at a significance level of 0.05.Results: At three months post-surgery, STDR was significantly lower on the intervention side (p < 0.05), indicating reduced soft tissue density and opacification. Endoscopic evaluation also showed a marked improvement in polyp and inflammation scores on the treated side. No significant differences were observed at one month. No major local or systemic adverse effects were reported.Conclusion: Topical application of low-dose imiquimod cream after endoscopic sinus surgery may effectively reduce inflammation, discharge, polyp formation, and opacification in the frontal sinus, and may be considered a safe preventive option for ostium stenosis. Larger trials are recommended to confirm these finding
Importance of Teaching Ultrasound- and Fluoroscopy-Guided Techniques in Vascular Access to Surgery Residents
Get PDFLetter to the Editor:Vascular access is a foundational clinical skill in surgical practice with wide applicability in trauma, vascular surgery, critical care, and interventional procedures. While traditional landmark-based techniques have long been taught, robust evidence supports the superiority of ultrasound-guided vascular access for increasing first-pass success, reducing complications, and improving overall patient safety. Similarly, fluoroscopy-guided access remains essential for complex vascular procedures and should be taught systematically early in surgical training.Ultrasound-guided access training has been shown to significantly improve procedural success and reduce safety risks compared to traditional techniques. Simulation-based curricula provide residents with repeated practice and objective feedback in a low-risk environment, leading to measurable performance gains. Moreover, simulation curricula specifically designed for femoral arterial access have demonstrated marked improvement in resident technical ability and confidence. In addition, novel educational interventions such as web-based and mastery learning systems show promise in facilitating skill acquisition even outside traditional clinical settings.Comparative studies have also highlighted procedural advantages of ultrasound guidance over fluoroscopy for common femoral artery access, including higher cannulation success and reduced inadvertent punctures—critical insights that ought to guide surgical education priorities. As surgical practice increasingly integrates imaging modalities into both elective and emergency workflows, formal training in ultrasound and fluoroscopic techniques must be incorporated into residency curricula to ensure graduating surgeons are competent, safe, and prepared for modern clinical demands.We therefore advocate for structured training modules in ultrasound- and fluoroscopy-guided vascular access, including dedicated simulation sessions, supervised clinical application, and objective competency assessments. Incorporating these skills into surgical residency education aligns training with contemporary practice, enhances patient safety, and equips future surgeons for the evolving scope of vascular and interventional care
Investigation of Biocompatible Wound Dressing and Skin Graft Treatment Methods in the Healing of Skin Wounds of 3rd Degree Burn Trauma in Motahari Hospital: A Clinical Trial
Get PDFBackground: One of the primary concerns among burn patients with third-degree skin injuries is the healingprocess and the severity of resulting skin lesions—an issue that has attracted considerable research attention.Accordingly, the present study aimed to evaluate the therapeutic effects of biocompatible wound dressings andskin grafting on the healing of third-degree traumatic burn wounds in patients admitted to Motahari Hospital.Methods: This semi-experimental randomized clinical trial was conducted in 2024. The study populationincluded 18 patients with third-degree traumatic burns covering less than 5 cm², referred to the Motahari BurnCenter in Tehran. Data were collected using a researcher-designed form. Statistical analyses were performedusing SPSS software, employing the Mann–Whitney and Spearman tests.Results: The mean age of participants was 36.25 years, and most were male (77.77%). The leading cause of burns was gas exposure (44.43%), and 66.68% of patients had burns covering 25% to 45% of total body surface area.Patients treated with biocompatible wound dressings experienced significantly less scar formation, improvedfollicle and dermal appendage restoration, and more aesthetically favorable skin regeneration.Conclusions: Addressing patients' concerns about wound healing is essential, and effective therapeuticapproaches should be employed. Based on the study's findings, the use of biocompatible wound dressings isrecommended in skin and burn recovery services
Rapid Progressive Synovial Sarcoma of Right Knee: A Rare Case Presentation
Get PDFBackground: Synovial sarcoma is a rare malignant soft tissue tumor that commonly emerges in the para-articular area, with the knee as the predominant location. The preferred intervention for this tumor is still currently debated Case description: We presented a 29-year-old male with a very large mass in the right knee. The physical examination revealed impairment of the right lower extremities, particularly the knee. MRI confirmed the extent of the pathology, but the first pathology analysis was inconclusive. A wide resection was performed without prior neoadjuvant therapy. The second pathology analysis from the resected tissue confirmed the diagnosis of biphasictype synovial sarcoma. The patient was able to walk with no assistance, had an increased range of motion, and the utmost preservation of the limb.Conclusions: We presented a successful case of wide resection of synovial sarcoma with a promising clinicaloutcome. The complexity of the case leads to the need for a tailored approach that should be limited tomusculoskeletal oncologists
Prevalence of Post-Traumatic Stress Disorder among Intensive Care Unit Survivors: A Prospective Study in Rasht, Iran
Get PDFBackground: Post-traumatic stress disorder (PTSD) is a psychological disorder resulting from a previoustraumatic experience. The objective of the present study was to investigate the prevalence of PTSD and its related risk factors among Intensive Care Unit (ICU) survivors.Methods: A total of 152 patients were followed up prospectively for one month. All included participants hadGlasgow Coma Scale scores ranging from 12 to 15. PTSD was assessed using a Persian-translated version of thePTSD Checklist (PCL). Data were analyzed using SPSS 22.0 software.Results: Among the participants, seventy-two (47.4%) men and eighty (52.6%) women with a mean age of 54.5± 19.19 years responded to the questionnaire. The prevalence of post-discharge PTSD was 87.5%. There wasa significant correlation between PTSD mean score and clinical factors such as hospitalization reason, self andfamilial history of psychological disorders, and Richmond Agitation Sedation Score (RASS) (p < 0.05).Conclusions: Our findings suggest that, despite often being ignored, post-discharge PTSD is a significantpsychological issue for ICU survivors. This highlights the importance of supportive care plans for patients witha history of mental disorders and agitation. The involvement of psychotherapists is crucial to improving postdischarge quality of life
Assessment of Emergency Nurses’ Knowledge and Awareness Regarding Peripheral Intravenous Extravasation: A Cross-Sectional Study
Get PDFBackground: Nurses play a crucial role in ensuring patient safety during intravenous therapy. Awareness of vascular extravasation is essential for preventing tissue injury and promoting evidence-based care. Considering the clinical importance of intravenous injections, their potential complications, and the limited awareness among emergency nurses, this study aimed to assess the level of knowledge regarding vascular extravasation among nurses working in the emergency departments of Khatam-al-Anbia and Ali Ibn Abi Talib hospitals in Zahedan.Methods: This cross-sectional descriptive study was conducted on 77 emergency department nurses from Khatam-al-Anbia and Ali Ibn Abi Talib hospitals in Zahedan during 2024–2025. Data were collected using a validated, researcher-developed questionnaire assessing six domains of extravasation knowledge. Statistical analysis was performed using SPSS version 24, and relationships between awareness scores and demographic variables were analyzed using the independent t-test, with the significance level set at p < 0.05.Results: The mean age of participants was 34.4 ± 6.8 years, and 62.3% were female. The overall mean knowledge score was 34.2 ± 5.6 (range: 19–46) out of a maximum of 72, indicating a generally low level of awareness. In total, 61% of nurses demonstrated low awareness and 39% demonstrated moderate awareness, while none achieved a high level. The results showed a significant association between awareness scores and both educational level and participation in training courses (p < 0.05), whereas no significant relationship was found with age, gender, or work experience.Conclusions: The findings indicate that a considerable proportion of emergency nurses possess inadequate knowledge regarding vascular extravasation. Structured and continuous training programs are strongly recommended to enhance awareness, improve prevention and management skills, and ensure safer intravenous practices in emergency settings
Autologous Fat Grafting Enhanced with Stromal Vascular Fraction (SVF) for Soft Tissue Reconstruction
Get PDFAutologous fat grafting continues to face a persistent challenge: retention rates that fluctuate unpredictablybetween 20% and 80%. The stromal vascular fraction (SVF)—a heterogeneous cell population containingadipose-derived stem cells and other regenerative cell types—has emerged as a promising adjunct. By romoting angiogenesis and supporting tissue regeneration, SVF enhances graft survival [1,2].This review examines current evidence on the mechanisms of SVF-enhanced fat grafting, the techniques usedfor its isolation, and the clinical contexts in which it has been successfully applied [3]. Literature publishedbetween 2015 and 2025 was analyzed, focusing on studies that investigated SVF-enriched fat grafting inreconstructive surgery [4]. Evidence indicates that enrichment with SVF im proves graft retention, with ratesrising to 65–80% compared to 40–65% achieved with conventional methods. Enhanced neovascularization hasalso been consistently reported [5,6]. Clinically, surgeons are applying SVF-assisted grafting in breastreconstruction, rehabilitation of radiation-damaged tissue, chronic wound management, and facial rejuvenation [7,8]. Both enzymatic digestion and mechanical separation techniques have proven effective for isolating SVF, offering flexibility depending on available resources and regulatory considerations [9,10]. Overall, SVF-enhanced fat grafting represents a significant advance in regenerative surgery. Multiple studies confirm its safety and therapeutic value, underscoring its potential to improve outcomes across a range of reconstructive and aesthetic applications [11,12]
The Immunology of Endometriosis and the Therapeutic Potential of Bispecific Antibodies: A Hypothesis
Get PDFEndometriosis is a chronic inflammatory disease characterized by the presence of endometrial lesions outside the uterus. Current treatment methods primarily focus on hormone-based therapy or invasive procedures. However, given the crucial role of the immune system in disease initiation and progression, there is an opportunity to explore new treatment approaches. Bispecific antibodies, which bind two different cells using their bivalent arms, have shown promise in treating cancers and autoimmune diseases. This study postulates that due to the similarities in pathogenesis between endometriosis and the aforementioned diseases, a novel therapeutic method based on this new target could be introduced. This could potentially lead to a reduction in limitations to patients' quality of life. In addition, it is important to highlight that future studies should prioritize the identification of specific binding markers on endometrial cells. This could contribute to the development of new diagnostic tools for the disease. Furthermore, the production of bispecific antibodies that selectively bind to these receptors on immune cells may prove effective in improving immune response
Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review
Get PDFBackground: Renal cell carcinoma (RCC) is a malignancy known for its high metastatic potential, commonlyspreading to the lungs, bones, brain, liver, and adrenal glands. Gallbladder metastasis from RCC is exceedinglyrare and poses significant diagnostic challenges due to its asymptomatic nature and nonspecific imaging findings.Case Presentation: We report the case of a 58-year-old Persian man with a history of clear cell RCC treatedwith left radical nephrectomy 34 months prior. The patient presented with right upper quadrant abdominal pain. Imaging studies, including contrast-enhanced computed tomography and ultrasound, revealed two hypervascular polypoid lesions within the gallbladder. An open cholecystectomy was performed due to the suspicion of malignancy. Histopathological examination confirmed metastatic clear cell RCC invading the gallbladder wall. Notably, immunohistochemical analysis showed tumor cells positive for cytokeratin 19, alpha-methylacyl- CoA racemase, and vimentin, but negative for paired box gene 8, cytokeratin 7, cytokeratin 20, and cluster of differentiation 117 (C-Kit). The absence of paired box gene 8 expression is atypical for RCC metastasis and posed a diagnostic challenge. The patient had an uneventful postoperative recovery but unfortunately passed away two months later due to a cerebrovascular accident unrelated to his oncological condition.Conclusions: This case underscores the importance of considering gallbladder metastasis in the differentialdiagnosis for patients with a history of RCC presenting with gallbladder lesions. The atypical immunohistochemical profile observed expands the known spectrum of metastatic RCC presentations and highlights the necessity for comprehensive diagnostic evaluation. Surgical intervention through cholecystectomy can lead to favorable outcomes and should be considered in similar cases
Successful Term Pregnancy After Cesarean Scar Molar Pregnancy
Get PDFBackground: Cesarean scar molar pregnancy (CSMP) is an exceptionally rare clinical entity, combining twouncommon obstetric conditions: cesarean scar pregnancy and molar gestation. The diagnosis is often delayed due to nonspecific symptoms and misinterpretation of imaging findings, and there is limited data regarding fertility outcomes following such cases Case Presentation: We report the case of a 32-year-old woman, gravida 2 para 1, who presented with vaginal bleeding and a diagnosis of missed abortion at 12 weeks gestation. Despite medical management with misoprostol, she experienced severe hemorrhage requiring surgical intervention. Intraoperative findings revealed thinning of the previous cesarean section scar and abnormal tissue suspicious for ectopic gestation. Pathologic examination confirmed a partial molar pregnancy implanted at the cesarean scar site. Following surgical repair and appropriate follow-up, including serial β-hCG monitoring until undetectable levels were reached, the patient conceived spontaneously two years later. The subsequent pregnancy progressed uneventfully to term and was delivered via cesarean section.Conclusions: This case highlights the importance of considering CSMP in the differential diagnosis of atypicalpregnancies in patients with a history of cesarean section, especially when imaging shows abnormal sac location or persistent bleeding. Early diagnosis and prompt management are crucial for patient safety and preserving fertility. To our knowledge, this is one of the rare reports of a successful term pregnancy following CSM