Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Effects of Different Techniques ("Surgical Versus Laser") on Impairment of Lymphatic Drainage and Scar Formation in Humans
Get PDFScars are abnormal changes in skin tissue caused by injuries, infections, and various factors. They commonlyresult from fibroblasts in affected skin synthesizing collagen, leading to irregular growth and excessive collagenaccumulation within the extracellular matrix.This study aims to investigate the effects of surgical and laser methods on scar formation mechanisms andlymphatic drainage, as well as their outcomes. The objective is to assess skin scars created by laser and surgicalincisions and their impact on pathophysiology and lymphatic flow in humans.A total of 20 patients with skin lesions were included in this study. The migration of methylene blue dye throughthe lymphatic vessels of the lower limbs was evaluated, with the administered dose limited to under 2 mg/kg.Transverse incisions were then performed distally using either a surgical blade or laser. The wounds were allowed to heal by secondary intention. The results indicated that laser-treated wounds did not heal completely, retaining a noticeable area of granulation tissue along with hair loss. In contrast, wounds created through surgical incisions healed entirely. Additionally, significantly lower dye migration levels were observed in the limbs after laser treatment compared to surgical incisions (p = 0.007). The findings suggest that scar size may be influenced by the type of incision used. However, further research is required to validate these results
Outcome of hemorrhoid artery ligation as a novel procedure for hemorrhoidal disease, case series in Shariati hospital of TUMS
Get PDFBackground: Hemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR) is a minimally invasiveprocedure designed to treat grades III and IV hemorrhoidal disease by addressing both vascular supply and tissue prolapse.Methods: This study retrospectively evaluated patients undergoing HAL-RAR between January 2024 andJanuary 2025. Data collected included demographics, disease severity, postoperative pain (Days 1 and 3),hospital stay, and time to first non-problematic defecation.Results: A total of 16 patients were included. Postoperative pain was low, with 62.5% reporting no pain onDay 1 and 88% on Day 3. Median pain scores decreased over time and were not significantly affected by sex.Defecation function recovered rapidly, with 100% achieving non-problematic defecation within two dayspostoperatively. Age showed a non-significant trend toward delayed recovery and slightly increased pain. Nomajor complications were observed, and all patients were discharged after one night.Conclusions: HAL-RAR appears to be a safe, well-tolerated, and effective short-term treatment for advancedhemorrhoidal disease, offering minimal pain and rapid functional recovery. However, larger studies with controlgroups and long-term follow-up are required to confirm these findings and evaluate durability
Primary Hepatic Pleomorphic Leiomyosarcoma: A Rare Case Treated with Curative Resection
Get PDFPleomorphic leiomyosarcoma (PLMS) is a rare malignant tumor of smooth muscle origin. Primary hepatic localization is extremely uncommon, with only a few cases reported in the literature. We present a case of primary hepatic PLMS diagnosed and surgically treated in our institution.An 83-year-old female presented with abdominal pain and vomiting. Her medical history included previous surgery for hepatic hydatid cyst. Laboratory analysis revealed elevated cholestatic enzymes and bilirubin levels. Dynamic liver CT showed a 200×136 mm hypodense lesion with septal enhancement in the right lobe extending partially to the left (Figure 1). Thoracic CT demonstrated right pleural effusion. After preoperative optimization, surgery was performed. Intraoperatively, a 30×20 cm semisolid mass was identified, and frozen section analysis suggested a borderline tumor. Extended right hepatectomy (trisectionectomy) involving the right and middle hepatic veins was performed. The postoperative course was uneventful, and the patient was discharged. Final histopathological examination confirmed the diagnosis of pleomorphic leiomyosarcoma. Primary hepatic PLMS is exceedingly rare. Curative surgical resection remains the mainstay of treatment and offers the best chance for long-term survival. This case highlights the importance of aggressive surgical management in rare hepatic sarcomas
Investigation of the Frequency of Abdominal Contrast-Enhanced CT Scan Findings in Multiple Trauma Patients Presenting to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in the Year 2023
Get PDFBackground: Despite the importance of this issue, the evidence-based indications for CT scans in chest traumahave not been widely investigated. This study examines the frequency of CT scan findings with abdominalcontrast in multiple trauma patients referred to the emergency department of Khatam Al Anbia Hospital inZahedan in 2023.Materials and Methods: This cross-sectional study was conducted in 2023 on 191 patients who referred tothe emergency department of Khatam Al-Anbia Hospital in Zahedan with complaints of multiple traumas andunderwent contrast CT scans of the abdomen. Sampling was easy and accessible. Data collection was done byobserving the results of CT scan reports of the patients. Data were analyzed after coding in SPSS.22 softwareusing tests and chi-square.Results: The average age of the patients was 44.87 ± 20.02 years, with a range of 15 to 89 years. In terms ofage distribution, 24 people (12.6%) were under 20 years old, 64 people (33.5%) were 21 to 40 years old, and103 people (53.9%) were over 41 years old. In terms of gender distribution, 79 people were women (41.4%)and 112 people (58.6%) were men. The most common abnormal findings were fractures in bone fragments in35 cases (18.3%), kidney damage in 28 cases (14.6%), and liver hematoma and free intra-abdominal fluid in 18cases (9.4%). The chi-square test showed that the findings of CT scans are significantly different according to age (P=0.039), mechanism of trauma (P=0.043), and type of clinical complaint (P=0.046).Conclusions: The present study showed that in terms of age, normal findings are more common in individualsunder 20 years old than in other age groups, and fractures in bone fragments are more common in people over 40 years old than in other age groups. In traffic accidents, the most common findings are fractures in bone fragments, while in fights, the most common findings are related to kidney damage. In clinical complaints with blood in the urine, the most common findings are related to rupture of the spleen and kidney damage, and in complaints of abdominal pain and distension, the most common findings are related to free fluid inside the abdomen and rupture of the spleen. These results can be effective in decision-making and diagnosis
Assessment of Sepsis Severity Using SOFA Score and Ultrasonographic Measurement of Optic Nerve Sheath Diameter
Get PDFBackground: This study aimed to compare optic nerve sheath diameter (ONSD) with SOFA score, mortality, andlength of stay in the intensive care unit (ICU) among patients with septic shock.Methods: An interventional study was conducted on 70 patients with sepsis admitted to the Shariati Hospital ICU.Demographic data were first recorded. Bedside ultrasonography through the upper eyelid was then performed to measure ONSD on admission and repeated on days three and six of ICU stay. Simultaneously, C- eactive protein (CRP), serum lactate levels, and SOFA scores were documented. The presence of encephalopathy was also evaluated. Statistical analyses using paired t-test and Pearson correlation were applied to examine associations between ONSD and clinical/laboratory parameters.Results: The mean age of patients was 60.42 ± 6.06 years, with 39 (54.2%) males. Encephalopathy was observedin 40 patients (55.6%). The mean ICU stay was 7.64 ± 2.40 days, and 39 patients (54.2%) died. ONSD showed asignificant correlation with serum lactate, CRP, and SOFA score (p < 0.05). The maximum mean ONSD was 6.0 mm on days one and three, decreasing to 5.6 mm by day six.Conclusions: ONSD, alongside CRP, lactate, and SOFA score, may serve as useful markers for monitoringneurological status, systemic inflammation, hemodynamic improvement, and organ function in septic shockpatients. These findings highlight their potential role in guiding timely ICU management, despite limitations such as sample size and demographic variability
A Research Study Assessing the Acceptance and Aesthetic Results of Split-Thickness Skin Grafts, Determined by The Timing of The Initial Postoperative Dressing
Get PDFBackground: Skin grafting is a procedure designed to restore the integrity of the skin. The primary reasons for skin graft failure include seroma, hematoma, and infection. These complications hinder the graft's adherence and revascularization, raising the risk of graft rejection, especially during the early postoperative period and aesthetic outcome later. Objective: The purpose of this study is to analyse graft acceptance and rejection due to seroma or infection, as well as the timing of the first check dressing on the third day compared to the fifth day and assessing the aesthetic outcome. Methods: A comparative and prospective study was conducted at our institution from June 2023 to July 2025 involving 200 patients who underwent split-thickness skin grafting (STSG) and were divided into two groups. In Group A, the initial postoperative dressing was applied on day 3, while in Group B, it was done on day 5. The second postoperative dressing occurred two days after the first. The skin grafted area was evaluated for incidence of seroma ,infection, the percentage of graft uptake and rejection, using both culture sensitivity testing and clinical observation. Results: The findings indicated that the average graft uptake in Group A was 88.5%, compared to 81.93% in Group B during the first dressing with better aesthetic outcome in group A. During the second dressing, Group A showed 88.24% and Group B showed 78.03% Conclusion: Performing the initial postoperative dressing on the third day after skin grafting significantly enhances final graft acceptance and aesthetic outcome.
 
Beyond The Covid 19 Pandemic; Incidentally Diagnosed Rib Tumors, A Case Series
Get PDFObjective: The rapidly spreading and fatal infection caused by the virus called COVID-19, primarily damages to the upper and lower respiratory tract. Thoracic CT scans, which have become an important tool in the diagnosis of the disease, can reveal asymptomatic cases in various organs such as the lungs, the thoracic wall, the mediastinum and even the upper abdominal organs. On the other hand, rib tumors are quite rare; most are benign and are usually detected incidentally during radiological examinations performed for other reasons. In this article, we present for the first time in the literature six cases of rib tumors that were incidentally detected and operated on during the pandemic era.Methods: A total of six patients, five female and one male, who underwent surgery with a diagnosis of rib tumor between March 2020 and October 2021 during the Covid-19 pandemic were included in the study.Results: None of them had obvious complaints suggesting rib pathology. 5 of 6 patients underwent en bloc partial rib resection with sufficient margins. No patient required prosthetic reconstruction, no malignant pathology was reported, and all patients were discharged within an average of 2.5 days.Conclusion: While the COVID-19 pandemic has cost humanity over two years, causing the deaths of approximately 7.5 million people and disability for many more, incidental findings during screening may have contributed to earlier diagnosis and treatment. While most rib tumors are benign, they should be considered potentially malignant until proven otherwise and should be operated on according to surgical principles
Assessment of Chest CT Scan Findings in Multiple Trauma Patients Admitted to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in 2023
Get PDFBackground: This study investigates the clinical predictors of chest CT scan findings in patients with chesttrauma presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan in 2023.Methods: A cross-sectional study was conducted on 460 patients with multiple traumas. Data were collected from CT scan reports and analyzed using SPSS 22 software, employing independent t-tests, correlation coefficients,and chi-square tests.Results:The mean age of the patients was 40.2 ± 20.36 years (range: 16–97). Gender distribution included 28.7%women and 71.3% men. Significant differences in CT scan findings were observed based on gender (P = 0.032),trauma mechanism (P = 0.029), and clinical complaint type (P = 0.017). Patients under 20 years old exhibitedmore normal findings, whereas those over 40 had a higher prevalence of rib and thoracic vertebra fractures.Traffic accidents and collisions frequently resulted in rib and thoracic vertebra fractures, while altercations weremore commonly associated with pneumothorax. Clinical complaints of chest pain and deformity were frequently linked to pneumothorax and rib fractures.Conclusions: These findings underscore the importance of age, trauma mechanism, and clinical complaints indiagnosing chest trauma, facilitating more informed decision-making and diagnosis
Modification in Brachytherapy Catheter Inset in the Keloid Bed
Get PDFBackground: Keloids are troublesome for both patients and surgeons who encounter recurrent lesions. Patients often seek newly developed treatments in hopes of alleviating the pain and manifestations associated with this condition. Surgery alone is generally ineffective and requires adjuvant therapies, one of which may bebrachytherapy.Case presentation: We introduced a modification in catheter placement following surgical excision of keloids.In the two presented cases, after lesion removal and closure of the deep cavity up to the subcutaneous tissue, the wound margins were closed while leaving a limited route for the catheter to prevent its displacement. The skin was then closed. The results of immediate post-surgical brachytherapy for keloids were highly encouraging.Conclusions: Brachytherapy following surgical keloid excision yields significant results. This combinationneeds more concise catheter inset especially in subcutaneous field
Apixaban-Associated Spontaneous Rectus Sheath Hematoma: A Geriatric Anticoagulation Dilemma in an 87-Year-Old Woman
Get PDFSpontaneous rectus sheath hematoma (RSH), a rare complication of anticoagulation therapy, can pose significant diagnostic and management challenges. We present the case of an 87-year-old woman with atrial fibrillation, hypertension, and chronic kidney disease (CKD) who developed spontaneous RSH while on apixaban. She presented with acute abdominal pain and a palpable mass, accompanied by anemia and coagulopathy. Non-contrast computed tomography (CT) confirmed a large rectus sheath hematoma. Conservative management, including discontinuation of apixaban, administration of tranexamic acid, and close monitoring, led to clinical improvement without requiring invasive intervention. This case underscores the importance of recognizing RSH in anticoagulated patients, particularly elderly individuals with renal impairment. Clinicians must maintain a high index of suspicion for atypical bleeding sites in patients on direct oral anticoagulants (DOACs) and consider conservative strategies when managing hemodynamically stable cases. The report highlights the need for individualized risk-benefit assessments when resuming anticoagulation and emphasizes patient education on bleeding risks