Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
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Inguinal Canal Hydatidosis Presenting as Irreducible Inguinal Hernia: A Case Report
Get PDFBackground: Hydatidosis is a parasitic infestation caused by Echinococcus granulosus. This tapeworm commonly affects liver and lungs. Its diagnosis in unusual locations may be make some challenges for practicing physicians.Case Report: A 45-year-old man presented with bulging and discomfort in the right lower quadrant from 2 years ago. Computed tomographic examination showed an oval cyst measuring about 7 cm × 15 cm in the inguinal area. In the operating room, after sealing the area with appropriate amounts of gauze soaked in silver nitrate the cyst punctured and clear fluid aspirated from the cyst; then, the cyst was sterilized using silver nitrate and opened. Daughter cysts were extracted from the cyst, the cyst was carefully freed from surrounding structures, and total excision of the cyst was performed. Post-operative period was uneventful, and no recurrence was encountered during the 6-month follow-up period.Conclusions: In this case, we present a patient with swelling in the inguinal area, which turns out to be hydatid cyst. To our knowledge, there has been no case of hydatid cyst arising primarily from inguinal canal. Hydatid disease can present with many different symptoms, and in this case, we present one the rare presentations of this disease. So that for a surgeon who works in the endemic areas, it is important to be aware about the varying presentations of the disease so that in the operation room should do required preparations to prevent unwanted serious problems such as spillage of intracystic materials
Determining the Clinicopathologic Features of Breast Lesions in Iranian Army Families
Get PDFBackground: Breast cancer is the most common disease of women around the world. On the other hand, benign breast diseases also constitute a wide range of breast pathologies that precise information on them is important. This study is conducted aiming to examine the breast pathology reports and determine the frequency of various breast diseases and its relationship with some clinicopathologic parameters in Imam Reza Hospital of army of the Islamic Republic of Iran in a period of 4 years.Methods: Imam Reza Hospital is a referral center for Army employees in Iran. This study is a retrospective descriptive study on patients who undertook biopsy or breast surgery during 2012-2015 in Imam Reza Hospital. After reviewing pathology reports and patient records and completing the required information, a total of 188 patients with 230 samples of breast tissue were included in this study.Results: During the period, 230 samples of breast tissue from 188 patients were sent to the pathology department. 195 samples (84.8%) were related to female patients and 35 samples (15.2%) to males. 112 samples (48.7%) were related to the left breast and 118 samples to the right (51.3%). The average size of tissues was 11.82 ± 8.64 cm. The mean age of patients was 42 ± 14.Conclusions: In this study, a statistically significant relationship exists between the patient sex and final diagnosis, patient age group and final diagnosis, and cell differentiation grade and lymph node metastasis along with samples. In the pathology reports in the center, cell differentiation grade of tumor was completely matched with Nottingham Grading System
Post-thyroidectomy Hypocalcemia and Pre-operative Vitamin D Levels
Get PDFBackground: Post-operative transient hypocalcemia is a common event after total thyroidectomy. It may reveal permanent hypoparathyroidism following total or subtotal thyroidectomy. It has been hypothesized that there is a relationship between underlying vitamin D deficiency and the risk of post-operative hypocalcemia.Methods: We performed a cross-sectional review on 100 thyroidectomies from 2016 at an academic teaching hospital. Pre-operative vitamin D levels and post-operative calcium level were obtained. The incidence of hypocalcemic symptoms was studied. Biochemical hypocalcemia was defined as any single post-operative corrected calcium level < 8.0 mg/dl (to convert to millimoles per liter, multiply by 0.25).Results: Post-operative calcemia < 8.0 mg/dl was observed in 19 patients (19%). We found that the patients carried a high risk for post-operative transient biochemical hypocalcemia if the pre-operative serum vitamin D levels ˂ 35 nmol/L. There was a significant differentiation between mean of vitamin D levels in hypocalcemic group and normocalcemic group.Conclusions: Pre-operative vitamin D levels appear to have a significant effect on the risk of post-thyroidectomy hypocalcemia
Placenta Percreta in the Uterus Fundus at the Second Trimester: A Case Report
Get PDFBackground: Placenta percreta is a rare complication of pregnancy with catastrophic outcomes for both mother and fetus. Abnormal placental attachment due to inadequate deciduas formation between trophoblast and myometrium is the main histological finding.Case Report: We present a case of placenta percreta in a 25-year-old woman accompanied by spontaneous uterine rupture at 25th week of gestation. In view of clinical symptoms and laboratory findings, the patient underwent laparotomy with a primary diagnosis of acute abdomen. We found no predisposing factor for abnormal placentation. As our patient wished to remain fertile, a successful uterine repair was performed.Conclusions: Histological assessment of the uterus showed placenta percreta. It is very rare for placenta percreta to cause uterine rupture in the second trimester, especially in a patient without any risk factors
Effects of Intraluminal Vancomycin in Decreasing Central Venous Catheter Infection
Get PDFBackground: Central venous catheters (CVC) are important intravenous routes, that nowadays they can be used for various reasons including resuscitation management, intravenous feeding, chemotherapy drugs, and blood transfusions. Due to the special importance and increasing usage of these catheters lengthening the duration of these catheters are very important. Infections are the most common cause of removal of this catheter.Methods: In this prospective study (cohort), 80 patients with central venous catheter were divided into two groups. In the first group Vancomycin once per day injected inside catheter equal to their intraluminal volume and remained for 2 h, then catheter was aspirated and washed. But in control group catheter was washed only with normal saline. Finally, catheter infection rates in the two groups were compared.Results: In the group that used intraluminal Vancomycin, catheter infection was observed in 3 cases and was confirmed by blood culture, but in none of them catheter infection agent was not Gram-positive cocci. In control group, 18 cases of catheter infection were confirmed by culture that in 16 cases were caused by Gram-positive cocci that in 14 cases catheter was removed, and in 2 cases of catheter infection, infectious agent was Staphylococcus epidermidis which catheter maintained with appropriate antibiotics.Conclusions: Use of the intraluminal Vancomycin significantly reduces the rate of infection and thus increase the survival rate of CVC
Tension-free Primary Closure, Secondary Intention, and Limberg Flap, Which Is More Effective in Treatment of Uncomplicated Pilonidal Sinus Disease?
Get PDFBackground: This study was performed to compare the efficacy and long-term outcomes of three surgical treatments for uncomplicated pilonidal sinus disease, tension-free primary closure, Limberg flap, and secondary intention (wide excision and packing).Methods: In this randomized clinical trial study, 66 patients with uncomplicated pilonidal sinus disease were randomly assigned to be surgically treated using tension-free primary closure, Limberg flap, or secondary intention methods. The outcomes including pain, healing time, recurrence, complications, disability, reoperation, and patient satisfaction were compared between three groups after two years of follow-up.Findings: In Limberg flap group, the healing time and disability were significantly less than the two other groups; besides, the pain was significantly less than secondary intention group and more than the primary closure group (P < 0.0001 for all). There were no significant differences between the groups regarding recurrence, complications, reoperation, and patient satisfaction (P > 0.05 for all).Conclusions: Totally, according to our findings and comparison with other studies, it may be concluded that Limberg flap is relatively better than primary and secondary intention in patients with uncomplicated pilonidal sinus disease
Photorefractive Keratectomy for Mild-to-Moderate Myopics with Thin Corneas: A 3-Year Follow-up Results
Get PDFBackground: The purpose of this study was to evaluate the 3-year visual outcomes in mild-to-moderate myopic patients with thin corneas who underwent photorefractive keratectomy (PRK) with or without mitomycin C (MMC).Methods: Thirty myopic eyes with a mean spherical equivalent (SE) of −3.76 ± 1.72 (−6.50 to −1.25) diopter (D) and a mean corneal thickness of 486.03 ± 11.93 (452-499) µm at the thinnest point underwent PRK. MMC was used if they had > 4.0 D myopia. All surgeries were performed with the VISX STAR S4 Excimer Laser (Abbott Medical Optics, Abbott Park, Illinois, USA).Results: Uncorrected visual acuity showed a significant improvement 3 years after surgery when compared to baseline and reached 0.01 ± 0.04 LogMAR (P < 0.001). Best-corrected visual acuity was 0.00 ± 0.01 LogMAR preoperatively and did not change significantly postoperatively. Spherical (P < 0.001) and cylindrical (P < 0.001) error significantly decreased. Manifest refraction SE showed a significant decrease when compared to before the operation and reached −0.08 ± 0.16 D (P < 0.001). At 3 years, mesopic contrast sensitivity was not significantly different from baseline at any spatial frequency. Vertical coma showed a significant decrease and reached −0.10 ± 0.27 µm (P = 0.004). Total coma (P < 0.001), spherical aberration (P < 0.001), and total high order aberrations (P < 0.001) also increased significantly.Conclusions: Based on the 3-year results, PRK (+MMC in patients with SE > 4.0 D) is a safe, effective, and predictable treatment option for mild-to-moderate myopic patients whose minimum corneal thickness is < 500 µm
Relationship between Phosphatase and Tensin Gene Expression and Clinicopathologic Features of Breast Cancer in Patients who Underwent Biopsy or Breast Surgery
Get PDFBackground: Phosphatase and tensin (PTEN) gene is a tumor suppressor gene on chromosome 10q23 that is composed of 11 exons. Several studies have shown that loss of PTEN function is a common occurrence in breast cancer in particular in triple negative type, and it is significantly associated with age and higher stage of cancer. In this study, the expression of this gene in malignant breast cancer tissue samples and their correlation with clinicopathologic parameters was studied.Methods: In this retrospective study, 65 malignant tissue samples were chosen for immunohistochemistry (IHC) test. Other information about clinicopathologic features were collected from pathology reports and patients’ medical records. IHC on the selected paraffin blocks was performed, and the collected data were analyzed using SPSS software and chi-square test. P < 0.0500 was considered statistically significant.Results: PTEN expression rate in malignant breast tissue was 50.8% of the cases (33 out of 65 samples). Lack of PTEN expression had significant correlation with involvement of the lymph node sent by the sample, vascular or perineural invasion, metastasis and chemotherapy background, spontaneous malignancy presence, familial history, negative progesterone receptor, negative estrogen receptor, and positive her2/neu. No relationship was observed between the expression of PTEN with patients’ age, tumor size, age group of the patients after categorization into two groups of under 50 years and over 50 years, lesion location (left or right breast), and tumor grade.Conclusions: The results showed PTEN loss as a frequent event in breast cancer that is closely associated with progression and poor prognosis. PTEN loss might predict more aggressive behavior and worse outcomes in patients with breast cancer
Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study
Get PDFBackground: Surgery for cholelithiasis is more common in elderly patients as the incidence of gallstones increases with age. Age is one of the critical factors affecting the mortality and morbidity rates after open cholecystectomy (OC). The aim of this report was to evaluate and comparing the outcome of laparoscopic cholecystectomy (LC) in elderly patients (≥ 65 years old) with that of OC.Methods: A prospective observational comparative study was conducted in the Department of General Surgery at R.G. Kar Medical College and Hospital, India, from January 2012 to June 2013. 50 patients were involved. Group 1 had patients planned for conventional LC, i.e., LC group and Group 2 with OC, i.e., OC group. Patients included were the cases who aged 65 years and above, with symptomatic gallstone disease, with asymptomatic gallstone with associated illnesses or with anticipated complications. Various variables were compared intraoperatively and postoperatively.Results: Significant differences were seen in LC group with more duration of surgery than OC group. The pain score was significantly low in LC group after 6 and 24 hours. The duration of hospital stay was also significantly less in LC group. Pulmonary function tests were done on 1st and 6th post-operative days showed a significant difference of peak expiratory flow rate, forced expiratory volume1, and forced vital capacity between LC and OC on 1st post-operative day.Conclusions: LC should be advised for elderly patients as an elective procedure safely as post-operative morbidity is much less in LC compared to the OC