به جمع مشترکان مگیران بپیوندید!

تنها با پرداخت 70 هزارتومان حق اشتراک سالانه به متن مقالات دسترسی داشته باشید و 100 مقاله را بدون هزینه دیگری دریافت کنید.

برای پرداخت حق اشتراک اگر عضو هستید وارد شوید در غیر این صورت حساب کاربری جدید ایجاد کنید

عضویت
فهرست مطالب نویسنده:

alireza rezapanah

  • Amin Dalili, Daryoush Hamidi Alamdari, Alimohamad Dalili, Maryam Sarkardeh, Alireza Rezapanah, Nooshin Tafazoli*

    Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.

    Keywords: Supralevator anorectal Abscess, Necrotizing Fasciitis, Platelet-Rich Plasma, Platelet-Rich Fibrin Glue
  • Masood Nezamdoost, Mohammad Reza Ghasemian, Hamid Salehiniya, Ali Fanoodi, Alireza Rezapanah, Mohsen Najmadini*
    Introduction

    Adopting a suitable strategy to reduce the complications of cholecystectomy plays a significant role in the well-being of patients. We investigated the effects of atorvastatin on clinical symptoms, and inflammatory markers of patients undergoing cholecystectomy.

    Methods

    This double-blind randomized controlled trial was conducted in Imam Reza Hospital, Birjand in 2021. In this study, 47 patients received 40 mg atorvastatin (intervention group) and 47 patients received placebo both daily for 4 weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C-Reactive Protein (CRP), Aspartate AminoTransferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05).

    Results

    The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05).

    Conclusions

    The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.

    Keywords: Cholecystitis, Acute, Cholecystectomy, Atorvastatin, C-Reactive Protein, Leukocyte Count, Aspartate Aminotransferases, Alanine Transaminase
  • Amin Dalili, Alireza Rezapanah, Maryam Sarkardeh, Mohammad Moein Shirzad, Tooraj Zandbaf, Sepehr Shirzadeh *
    Background

    The etiology of pelvic organ prolapse is multifactorial. Age and parity are especially the two most important risk factors for this condition. Small bowel obstruction is one of the most common clinical presentations to the emergency department that can result in significant morbidity and mortality.

    Case presentation

    A 79-year-old woman with a previous history of uterine prolapse and no previous history of intraabdominal surgery or malignancies presented with nausea and vomiting, abdominal pain, and constipation from 2 days ago. Upright and supine x-rays showed dilated small bowel loops and confirmed bowel obstruction. Due to primary obstruction, the patient was a candidate for surgery. During the surgery, we observed that 100 cm of the terminal ileum and the uterus protruded in the vaginal canal and the ileal loops were strangulated. We decided to perform a right hemicolectomy surgery.

    Conclusion

    In patients with uterine prolapse, we suggest a careful examination and consideration of the entrapment of small bowel loops in the prolapse site as a rare cause of small bowel obstruction.

    Keywords: Case report, Intestinal obstruction, Pelvic organs prolapse, Small bowel obstruction, Uterine prolapse
  • Maryam Sarkardeh, Alireza Rezapanah, Aida Ayati Afin, Ali Shamshirian, Zahra Sadrzadeh, Javad Koushki, Amin Dalili
    Background

    Coronavirus disease 2019 (COVID-19) involves multiple organs, including the gastrointestinal tract. It also causes frequent thromboembolic events because of its thrombogenicity. This study reports a COVID-19 case of extensive bowel necrosis despite using warfarin.

    Case Presentation

    A 52-year-old homeless addict male was brought via Emergency Medical Services with a chief complaint of abdominal pain for two days and loss of consciousness since the day before. He had a history of cough and dyspnea for seven days and had been using warfarin after mitral valve replacement three years earlier. On admission, he had low oxygen saturation, tachycardia, and fever. Because of his respiratory signs and symptoms, a chest CT scan was performed, and evidence of COVID-19 infection was detected. He had nausea, and on abdominal examination, there was generalized tenderness, rebound tenderness, and guarding. Following physical examination and abnormal laboratory test results,he underwent an emergent laparotomy. Extensive necrosis made surgical intervention impossible, and he died shortly after the surgery.

    Conclusion

    COVID-19-associated coagulopathy raises many challenges nowadays, and according to the present case, even using anticoagulants may not prevent it.

    Keywords: ACE-2 receptors, Bowel necrosis, COVID-19, Vasculitis, Warfarin toxicity
  • Maryam Sarkardeh, Amin Dalili, Poorya Etesamyzade, Ali Shamshirian, Zahra Sadrzadeh, Javad Kooshki, Maryam Khoshdast, Alireza Rezapanah
    Background

    Bythe end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The highaffinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some rare complications of Covid-19 infection with high morbidity and mortality resulting from colonic hypoperfusion. Different underlying mechanisms for ischemic colitis in Covid-19 patients have been described, including hypercoagulable state, inflammatory responses, microthrombosis, and non-occlusive intestinal ischemia due to shock, hypoxemia, and low cardiac output.

    Case Presentation

    here, we presented three patients with ischemic colitis and one rectal necrosis as a rare presentation of gastrointestinal complication of SARS-CoV-2 infection. All of our patients presented with abdominal pain and tenderness and received a standard regimen of antibiotics, anticoagulation, and ventilation support.

    Conclusion

    Ischemic colitis is one of these rare but with high mortality manifestations, which presents with non-specific signs and symptoms. Hence, ischemic colitis should be kept in mind in patients with Covid-19 infection and abdominal pain, which necessitates further evaluations.

    Keywords: Abdominal CT Scan, COVID-19, Rectum infarction
  • علیرضا رضاپناه، علیرضا قنبری*

    پورپورای هنوخ شوین لاین (HSP)، نوعی التهاب منجر به انسداد عروق کوچک (1) با عوارض پوستی و سیستمیک است (2). این بیماری شایع ترین واسکولیت در سنین کمتر از 10 سال، با شیوع بیشتر در پسران است. بیماری با یک واسکولیت لکوسیتوکلاستیک که عروق کوچک را درگیر کرده، همراه با شواهدی از کمپلکس های ایمنیون شامل Iga مشخص می شود (3). بر خلاف سایر واسکولیت های سیستمیک، این بیماری معمولا خود محدود شونده بوده، با چهار علامت بالینی از جمله درگیری کلیه، درد شکمی، آرتریت یا درد مفصلی و پورپورای قابل لمس بدون اختلال انعقادی یا افت تعداد پلاکت تشخیص داده می شود بیماری هنوخ شوین لاین نوعی التهاب منجر به انسداد عروق کوچک است که غالبا در کودکان مشاهده می شود. شروع این بیماری در سنین بزرگسالی، ناشایع و با سندروم بالینی شدیدتر و پیامدهای بدتری همراه است. ما یک مورد پرفوراسیون وسیع در ایلیوم رادر آقایی 40 ساله مورد واسکولیت و تحت درمان با کورتیکواسترویید که با درد شکم منتشر همراه با تندرنس و ریباند در معاینه، کاندید جراحی شده است را معرفی می کنیم.

    کلید واژگان: هنوخ شون لاین, واسکولیت, ایلئوم
    Alireza Rezapanah, Alireza Ghanbari *

    Henoch Schoenline (HSP) purpura is a type of inflammation that results in blockage of small blood vessels (1) with skin and systemic complications (2). It is the most common vasculitis in children under the age of 10, with the highest prevalence in boys. The disease is characterized by a leukocytoclastic vasculitis involving small vessels, along with evidence of immune complexes including Iga (3). Unlike other systemic vasculitis, the disease is usually self-limiting, with four clinical symptoms including kidney involvement, abdominal pain, arthritis or joint pain, and palpable perforation without coagulation disorder or a decrease in platelet count. It leads to blockage of small blood vessels, which is often seen in children. The onset of the disease in adulthood is uncommon and is associated with more severe clinical syndrome and worse outcomes. We present a case of extensive perforation in the ileum in a 40-year-old man with vasculitis and treated with corticosteroids who have been operated on with a diffuse abdominal pain with a tendon and rebound on examination.

    Keywords: Henoch Schoenline, Vasculitis, Ileum
  • علی جنگجو، تورج زندباف*، علیرضا رضاپناه، علی وحیدی راد، سینا نوروزی اصل، اکبر پاکدل
    زمینه و هدف

    کیستهای ربع فوقانی چپ شکم (LUQ) اغلب به طور اتفاقی کشف می شوند. با توجه به فقدان روش های اختصاصی جهت تشخیص قطعی ضایعات مستعد بدخیمی، مدیریت کیستهای LUQ از اهمیت بسزایی برخوردار است. در این راستا، آگاهی از تشخیص های افتراقی (مانند کیستهای آدرنال و پانکراس)، کاربرد روش های تصویربرداری و اندیکاسیون های جراحی بسیار مهم است.

    معرفی مورد

    بیمارخانمی 56 ساله با سابقه کیست آدرنال چپ که به علت درد  LUQ بعد از غذا خوردن به سرویس جراحی ارجاع شد. سونوگرافی و سی تی اسکن نشان دهنده یک ضایعه کیستیک 120 میلیمتری در آدرنال چپ بود. بیمار کاندید جراحی لاپاراسکوپی شد. در حین جراحی و بر خلاف تشخیص اولیه، یک کیست بزرگ به اندازه حدود 150 میلیمتر با منشاء دم پانکراس و گرفتاری عروق طحالی آشکار گردید که دیستال پانکراتکتومی و اسپلنکتومی انجام شد. بررسی پاتولوژی حاکی از یک نیوپلاسم موسینوس توبولوپاپیلری با دیس پلازی درجه بالا به همراه یک کانون کوچک کارسینوم تمایز نیافته پانکراس به اندازه 5 میلیمتر بود.

    بحث و نتیجه گیری

    روش های تصویربرداری فعلی قادر به تشخیص قطعی منشاء کیستهای بزرگ  LUQ نیستند که این مسئله زمینه ساز بروز خطا در مدیریت ضایعات بدخیم پانکراس یا آدرنال می شود. از این رو چنین به نظر می رسد که استفاده از روش لاپاراسکوپی، علاوه بر مزایای کم تهاجمی مانند درد کمتر، کاهش دوره بستری و بازگشت سریعتر به فعالیت های روزمره، می تواند به تشخیص درست حین جراحی کمک کرده و امکان تصمیم گیری مناسب را برای جراح فراهم سازد.

    کلید واژگان: کیست LUQ, کیست پانکراس, کیست آدرنال, لاپاراسکوپی
    Ali Jangjo, Tooraj Zandbaf *, Alireza Rezapanah, Ali Vahidirad, Sina Noruzi Asl, Akbar Pakdel
    Background

    Left Upper Quadrant (LUQ) cysts are often discovered by accident. Due to the lack of specific methods for the definitive diagnosis of premalignant lesions, the management of LUQ cysts is of great importance. In this regard, Awareness of differential diagnoses (such as adrenal and pancreatic cysts), the use of imaging techniques, and surgical indications are very important.

    Case presentation

    A 56-year-old woman with a history of the left adrenal cyst was referred to the Department of Surgery for LUQ pain after eating. Abdominal ultrasound and CT scan showed a 120 mm cystic lesion of the left adrenal gland. The patient was a candidate for laparoscopic surgery. During surgery and contrary to the initial diagnosis, a large cyst about 150 mm in the tail of the pancreas was detected by the involvement of the splenic vein and artery. Distal pancreatectomy and splenectomy were performed. Pathological examination revealed a mucinous tubulopapillary neoplasm with high-grade dysplasia along with an undifferentiated pancreatic carcinoma that was as small as 5 mm.

    Discussion and conclusion

    Current imaging techniques are not able to pinpoint the origin of large LUQ cysts, which can lead to errors in the management of malignant lesions of the pancreas or adrenal. Therefore, it seems that the use of the laparoscopic method not only has advantages such as less pain, reduced hospitalization period, and faster return to daily activities but also can help make the correct diagnosis during surgery and allow the surgeon to make the right decision.

  • یوسف حقیقی مقدم، آرش علی اصغری*، جمال احمدزاده، علیرضا رضاپناه
    پیش زمینه و هدف

     دلیریوم نوعی اختلال شناختی نوساندار بوده که تشخیص زودرس آن موجب کاهش عوارض و مرگ ومیر و همچنین تسریع و کاهش هزینه های درمان می شود. ابزارهای بسیار زیادی جهت شناسایی و غربالگری دلیریوم وجود دارد، ازجمله این ابزارها، ابزار CAM-ICU است. هدف مطالعه حاضر بررسی مقایسه ای دو روش آموزشی به شیوه مولتی مدیا و روش مرسوم بر دانش و عملکرد پرستاران در به کارگیری معیار CAM-ICU در بیماران بستری در بخش های مراقبت ویژه مرکز آموزشی درمانی دانشکده علوم پزشکی خوی بوده است.

    مواد و روش کار

    این مطالعه به روش کارآزمایی بالینی با گروه های موازی انجام شد. به منظور دستیابی به اهداف پژوهش به مراکز آموزشی درمانی دانشکده علوم پزشکی شهرستان خوی مراجعه شد، تعداد 80 نفر به روش سرشماری انتخاب شدند. آن ها سپس به شکل تصادفی به دو گروه آموزش به روش مرسوم و مولتی مدیا تقسیم شدند. پرسشنامه های دانش و چک لیست عملکرد به صورت پیش آزمون و پس آزمون پس از انجام مداخله در هر دو گروه تکمیل شد. سپس اطلاعات توسط نرم افزار SPSS نسخه 22 کدبندی و تحلیل گردید.

    یافته ها

    نتایج مطالعه نشان داد که بین هیچ کدام از متغیر های کیفی پرستاران در دو گروه مداخله و کنترل تفاوت معناداری ازنظر آماری وجود نداشت. همچنین ازنظر سطوح دانش بین دو گروه مداخله و کنترل قبل و بعد از مداخله، تفاوت معنی داری ازنظر آماری وجود نداشت. ولی بعد از مداخله میانگین نمره عملکرد از 450/2 در گروه مداخله به 575/4 و دانش آنان از 17/10 به 10/13 تغییر یافت (0.05<p). هرچند این افزایش در هر دو گروه دیده شد ولی میزان افزایش در گروه مداخله نسبت به گروه کنترل ازنظر آماری بیشتر و معنی دار بوده است (0.001=p).

    بحث و نتیجه گیری

    بر اساس یافته های پژوهش حاضر، هر دو روش آموزشی به شیوه مولتی مدیا و روش مرسوم بر دانش و عملکرد پرستاران در به کارگیری معیار CAM-ICU در بیماران بستری در بخش مراقبت های ویژه تاثیر مثبت و معنی داری دارند. ولی ازنظر نمره میانگین عملکرد، روش مولتی مدیا موثرتر از روش مرسوم بود. بنابراین استفاده از روش آموزشی چندرسانه ای می تواند به عنوان یک راهکار برای پاسخگویی به نیازهای مبرم آموزش در پرستاری مطرح باشد.

    کلید واژگان: پرستاران, بخش مراقبت ویژه, آموزش سنتی, آموزش مولتی مدیا, دلیریوم
    Yusef Haghighimoghadam, Arash Aliasghari*, Jamal Ahmadzadeh, Alireza Rezapanah
    Background & Aims

    Delirium is a fluctuating cognitive disorder that early diagnosis of it, reduces complications and mortality while accelerating treatment and decreasing costs. There is various used for detection and screening delirium; one of which is the CAM-ICU. The present study aimed to compare the effects of multimedia and traditional methods on nurses’ knowledge and performance in applying the CAM-ICU criterion in the patients admitted to intensive care units of Educational-Medical Centers of Khoy University of Medical Sciences.

    Materials & Methods

    This study was performed using a clinical trial method with parallel groups. To achieve the research objectives, 80 subjects were selected from Educational-Medical Centers of Khoy University of Medical Sciences using the census method. Then they were randomly divided into two groups of multimedia and traditional methods. They then completed Knowledge Questionnaire and Performance Checklist as pretest and posttest after the intervention in both groups. Data were then coded and analyzed by SPSS software version 22.

    Results

    The results showed that there was no statistically significant difference between any of the qualitative variables of nurses in the intervention and control groups. Also, in terms of knowledge levels, there was no statistically significant difference between the intervention and control groups before and after the intervention. However, the mean performance score changed from 2.450 to 4.575 and their knowledge changed from 10.17 to 13.10 (P <0.05) in the intervention group after the intervention. Although this increase was seen in both groups, but the increase level in the intervention group was statistically higher than that in the control group (P = 0.001).

    Conclusion

    Based on the findings of the present study, both multimedia teaching and conventional methods have a positive and significant effect on nurses' knowledge and practice in applying the CAM-ICU criterion to the patients admitted to the intensive care unit; however, in terms of average performance score, the multimedia method is more effective, So the use of multimedia training method can be considered as a solution to meet the urgent needs of education in nursing.

    Keywords: Nurses, Intensive Care Unit, Traditional Education, Multimedia, Delirium
  • Ali Jangjoo, Abdul Rahman Sadeed, Alireza Rezapanah, Tooraj Zandbaf*
    Background

    The association between gastroesophageal reflux disease (GERD) and obesity with a prevalence of 50-100% has been proven, while 8-26% of non-obese patients experienced GERD. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for obese patients with GERD. RYGB can accelerate gastric emptying and thus improve reflux symptoms.

    Case presentation

    A 56-year-old man weighing 101 kg and 167 cm tall (BMI 36.2) presented to the hospital with major complaints of obesity and mild gastroesophageal reflux disease. He also suffered from comorbidities like DM, HTN, and IHD. 15 years ago he underwent Nissen Fundoplication due to severe GERD. We candidate the patient for LRYGB surgery because of obesity, Mild reflux, and comorbidities such as DM, and HTN. Due to past fundoplication, severe adhesions, and fibrosis at the last operation site, LRYGB without Wrap taken down was done.

    Discussion

    Laparoscopic conversion of Fundoplication to RYGB is a complex technique because of extended operative time, morbidity, and length of hospital stay. RYGBP after fundoplication leads to more complications than other forms of reoperative bariatric surgery; however, it gives a good weight loss that satisfies the patient.

    Conclusion

    LRYGB after previous anti-reflux surgery without wrap takedown is technically safe and brings in reflux symptoms and comorbidities improvement, satisfactory weight loss, and less morbidity.

    Keywords: LRYGB, GERD, Reoperative Antireflux Surgery, Nissen Fundoplication, Case Report
  • Alireza Tavassoli, Tooraj Zandbaf*, Alireza Rezapanah
    Background

    Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients.

    Case presentation

    Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown.

    Conclusion

    Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy. Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.

    Keywords: Case report, Cholecystectomy, Cholecystitis, Cholelithiasis, Laparoscopic situs inversus totalis
  • علی جنگجو، تورج زندباف*، علیرضا رضاپناه، علی وحیدی راد، سینا نوروزی اصل، اکبر پاکدل
    زمینه و هدف

    کیستهای ربع فوقانی چپ شکم (LUQ) اغلب به طور اتفاقی کشف می شوند. با توجه به فقدان روش های اختصاصی جهت تشخیص قطعی ضایعات مستعد بدخیمی، مدیریت کیستهای LUQ از اهمیت بسزایی برخوردار است. در این راستا، آگاهی از تشخیص های افتراقی (مانند کیستهای آدرنال و پانکراس)، کاربرد روش های تصویربرداری و اندیکاسیون های جراحی بسیار مهم است.

    معرفی مورد

    بیمارخانمی 56 ساله با سابقه کیست آدرنال چپ که به علت درد  LUQ بعد از غذا خوردن به سرویس جراحی ارجاع شد. سونوگرافی و سی تی اسکن نشان دهنده یک ضایعه کیستیک 120 میلیمتری در آدرنال چپ بود. بیمار کاندید جراحی لاپاراسکوپی شد. در حین جراحی و بر خلاف تشخیص اولیه، یک کیست بزرگ به اندازه حدود 150 میلیمتر با منشاء دم پانکراس و گرفتاری عروق طحالی آشکار گردید که دیستال پانکراتکتومی و اسپلنکتومی انجام شد. بررسی پاتولوژی حاکی از یک نیوپلاسم موسینوس توبولوپاپیلری با دیس پلازی درجه بالا به همراه یک کانون کوچک کارسینوم تمایز نیافته پانکراس به اندازه 5 میلیمتر بود.

    بحث و نتیجه گیری

    روش های تصویربرداری فعلی قادر به تشخیص قطعی منشاء کیستهای بزرگ  LUQ نیستند که این مسئله زمینه ساز بروز خطا در مدیریت ضایعات بدخیم پانکراس یا آدرنال می شود. از این رو چنین به نظر می رسد که استفاده از روش لاپاراسکوپی، علاوه بر مزایای کم تهاجمی مانند درد کمتر، کاهش دوره بستری و بازگشت سریعتر به فعالیت های روزمره، می تواند به تشخیص درست حین جراحی کمک کرده و امکان تصمیم گیری مناسب را برای جراح فراهم سازد.

    کلید واژگان: کیست LUQ, کیست پانکراس, کیست آدرنال, لاپاراسکوپی
    Ali Jangjoo, Tooraj Zandbaf *, Alireza Rezapanah, Ali Vahidirad, Sina Norouzi Asl, Akbar Pakdel
    Background

    Left Upper Quadrant (LUQ) cysts are often discovered by accident. Due to the lack of specific methods for the definitive diagnosis of premalignant lesions, the management of LUQ cysts is of great importance. In this regard, Awareness of differential diagnoses (such as adrenal and pancreatic cysts), the use of imaging techniques, and surgical indications are very important.

    Case presentation

    A 56-year-old woman with a history of the left adrenal cyst was referred to the Department of Surgery for LUQ pain after eating. Abdominal ultrasound and CT scan showed a 120 mm cystic lesion of the left adrenal gland. The patient was a candidate for laparoscopic surgery. During surgery and contrary to the initial diagnosis, a large cyst about 150 mm in the tail of the pancreas was detected by the involvement of the splenic vein and artery. Distal pancreatectomy and splenectomy were performed. Pathological examination revealed a mucinous tubulopapillary neoplasm with high-grade dysplasia along with an undifferentiated pancreatic carcinoma that was as small as 5 mm.

    Discussion and conclusion

    Current imaging techniques are not able to pinpoint the origin of large LUQ cysts, which can lead to errors in the management of malignant lesions of the pancreas or adrenal. Therefore, it seems that the use of the laparoscopic method not only has advantages such as less pain, reduced hospitalization period, and faster return to daily activities but also can help make the correct diagnosis during surgery and allow the surgeon to make the right decision.

    Keywords: LUQ cyst, Pancreatic cyst, Adrenal cyst, Laparoscopy
  • Adeleh Hashemi Fard, Hormoz Hoseinpour Deyrestani, Hamed Golmohamadi, Alireza Rezapanah

    Hydatid disease is mainly because of the Echinococcus granulosus at the larval stage. The liver and lung are its most consequences. The pancreatic hydatid cyst (PHC) incidence is very low (0.14%-2%). A 55-year-old female patient presented with epigastric pain for the last one year that the pain did not continue but during one months ago suffered continually. In physical examination, there was not any abdominal bulb, tenderness and rebound tenderness. A 54×59 mm cystic structure was observed by ultrasonography (USG) and Contrast-enhanced Computed Tomography (CT) in the pancreatic body with stone in the gallbladder. Amylase, lipase, and LFT levels were normal. The Anti-hydatid antibody was positive. During laparoscopic exploration, a hydatid cyst was found. Partial cystectomy with external drainage and cholecystectomy was performed once irrigation with scolicidal agent and evacuation of cystic contents was conducted. Histopathological biopsy reported Hydatid cyst. A pancreatic, hepatic cyst is a rare event. Hematogenous is the most common spread way. Cysts in the pancreatic head could be found with obstructive jaundice. Usually, cysts in the body and tail are known to be asymptomatic. USG, CT, and Hydatid serology are useful with the clinical diagnosis as well as monitoring the recurrence. An exploration via surgery is an option that includes pericystectomy, partial cystectomy with/without external drainage or omentopexy, marsupialization, or cysto-enterostomy, which is done. What makes this case unique is the laparoscopic method that we used instead of open surgery, which is a treatment of choice. The recommendation is pre-operative and postoperative antihelminthic (Albendazole). PHC could be present as pseudocyst or cystic neoplasm of the pancreas. For patients with endemic regions and laparoscopic surgery, differential diagnosis of the cystic pancreatic lesion should be noticed. Common surgery approach could be considered for such patients.

    Keywords: Hy datid cy st, Pancreatic cy st, Lap aroscop y
  • Mohammadreza Motie, Alireza Rezapanah, Hadi Abbasi, Bahram Memar, Arash Arianpoor
    Background
    As there is an established relationship between Helicobacter pylori infection and gastric and duodenal ulcers, there might also be a relationship between this infection and other pathologies of gastrointestinal system.
    Objectives
    Thus in this study we decided to investigate the relationship between H. pylori infection and cholecystitis.
    Methods
    In this case-control study, patients were divided into two groups: case group with cholecystitis or cholelithiasis and controls with normal gallbladder. In both groups, after removal of the gallbladder, the samples were sent to the pathology laboratory for further evaluation. The presence of H. pylori gene in gallbladder tissue was determined by PCR (Polymerase chain reaction), and the results were compared between the groups.
    Results
    A total of 84 studied patients with mean age of 45.19 ± 1.78, 27 were male (32.1%) and 57 were female (67.9%). Results showed that among the studied variables, only height (P value = 0.002) and BMI (P value = 0.001) were significantly different between the two groups.
    Conclusions
    Although correlation between the prevalence of bacteria in gallbladder with the incidence of gallstones is a controversial issue, but studies suggested that higher prevalence of H. pylori in patients with cholecystitis caused by gallstones can be a stimulating factor for the formation of gallstones.
    Keywords: Cholecystitis, Cholelithiasis, Gallstone, PCR, Helicobacter pylori
  • سید حسن طاووسی، علی احمدآبادی*، مجید خادم رضاییان، علیرضا رضاپناه، مریم رشچی، مریم احمدی حسینی، زهرا آهنجان
    مقدمه آلوگرافت پوستی استاندارد طلایی، پوشش موقت زخم های سوختگی می باشد. حتی در سوختگی های درجه 2 این روش در مقایسه با درمان آنتی میکروبیال موضعی، طول مدت بستری و موربیدیته را کاهش می دهد. با این وجود مطالعه ای در مورد اثرات استفاده از آلوگرافت در بقای بیماران سوختگی در ایران انجام نشده است. هدف مطالعه حاضر بررسی تاثیر استفاده از آلوگرافت پوستی در طول مدت بستری و مرگ و میر بیماران در مرکز ارجاعی سوختگی بیمارستان امام رضا (ع) در شرق کشور می باشد.
    روش کار مطالعه حاضر به صورت مورد شاهدی بر روی بیماران سوختگی ماژور بستری شده در بیمارستان امام رضا (ع) مشهد در دوره زمانی ابتدای مهر ماه سال1389 تا پایان شهریور سال1393 که تحت عمل آلوگرافت پوستی قرار گرفته بودند، انجام شد. گروه شاهد را بیماران بستری شده در بخش سوختگی تشکیل می دادند که تحت آلوگرافت قرار نگرفته بودند و از نظر سن، جنس و درصد سوختگی با گروه مورد همسان سازی شدند. پیامد مورد بررسی، مدت زمان بستری بودن بیمار، وضعیت در زمان ترخیص (زنده، فوت شده) بود. نرم افزار آماری SPSS (نسخه 5/11) برای تحلیل نتایج به کار گرفته شد. منحنی بقای کاپلان مایر و آزمون رتبه لگاریتمی برای مقایسه بقا در دو گروه و رگرسیون کاکس برای یافتن عوامل پیش بینی کننده مرگ به کار رفت.
    نتایج
    56 بیمار در گروه مورد و 112 نفر در گروه شاهد، تحت مطالعه قرار گرفتند. میزان مرگ در مدت بستری در دو گروه تفاوت معنی داری نداشت (434/0=p). اما تعداد روزهای بستری در گروه مورد (9/13 ± 39) به طور معنی داری بیشتر از گروه شاهد (5/14 ± 8/21) بود(001/0=p). میانگین زمان بقا در گروه مورد (51 روز، دامنه اطمینان 95%= 45-56) بیشتر از گروه شاهد (48 روز، دامنه اطمینان 95%= 39-58) بود(017/0=p). سن(070/1 – 005/1=%95،CI 03/1=OR) و تعداد دفعات استفاده از آلوگرافت (945/0 – 142/0=95%،CI 038/0=OR) متغیرهای پیشگویی کننده مرگ بودند.
    نتیجه گیری
    اگر چه استفاده از آلوگرافت پوستی در سوختگی های وسیع (بیش از 50%) موجب کاهش مرگ و میر بیماران سوختگی شد، ولی استفاده از آن در سوختگی های کمتر از 50% در کاهش مرگ و میر بیماران موثر نبوده است. پیشنهاد می شود با توجه به محدودیت دسترسی در اکثر مراکز سوختگی کشور، بیماران دچار سوختگی وسیع برای استفاده از این فرآورده نجات بخش در اولویت قرار گیرند.
    کلید واژگان: آلوگرافت پوستی, سوختگی, بقا, مشهد, طول مدت بستری
    Seyed Hasan Tavousi, Ali Ahmadabadi *, Majid Khadem-Rezaiyan, Alireza Rezapanah, Maryam Rashchi, Maryam Ahmadi Hoseini, Zahra Ahanjan
    Introduction
    Skin allograft is the gold standard for temporarily covering the burn injury. Even in partial thickness burns, skin allograft in comparison to topical antimicrobial dressing, can reduce morbidity and hospital stay in burn patients. However, there is not any study about the effects of skin allograft on survival of burn patients in this country. The aim of this study was to evaluate the impact of allograft usage on hospitalization period and mortality in Imam Reza(p) hospital referral burn center in the East of the country.
    Subjects &
    Methods
    This case-control study was performed on major burn patients who underwent skin allografts in Imam Reza(p) hospital in Mashhad between September 23, 2010 and September 22, 2014. The control group comprised patients hospitalized in the burn ward who were not undergoing allograft surgery. They were matched for age, sex and percentage of burn with case group. Study outcome was the hospitalization period and the patient's status at discharge (alive, deceased). Data were analyzed by SPSS version 11.5 using Kaplan–Meier and Log-rank test. Cox -regression was used to find predictors of death.
    Results
    Overal, 56 patients in the case group and 112 patients in the control group were studied. The death rate in the two groups was not statistically different (P = 0.434), but hospitalization period in the case group (39 ± 13.9) was significantly longer than the control group (21.8 ± 14.5)(P
    Conclusion
    Although the use of allograft skin in extensive burns (over 50%) reduced the mortality of burn patients, but it was ineffective in burns less than 50 percent. Considering the shortage of skin allograft in most burn centers in this country, it is advisable to reserve this life-saving product for extensively burnt patients.
    Keywords: Skin allograft, Burn, Survival, Mashhad, Hospitalization period
  • Mohammadreza Motie, Mohsen Aliakbarian, Alireza Rezapanah
    Hand metastasis accounts for approximately 0.1 percent of all metastatic osseous malignancies. The lung, breast and kidney are the most common primary sources of these metastatic lesions.A rare case of retroperitoneal alveolar soft part sarcoma metastasizing to the distal phalanx of the second finger of the right hand is presented here. The patient underwent complete DIP amputation of the affected finger and was referred to oncologist for further therapeutic workups. Acrometastases run a poor prognosis; thus, palliative treatment is in the patient’s best interest.
    Keywords: Sarcoma, Alveolar Soft Part, Neoplasm Metastasis, Finger Phalanges
  • Mohammadreza Moti, Mohsen Aliakbarian, Alireza Rezapanah
    Background
    Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm originating from soft tissue. It was initially described as a distinctive clinical entity by Christopherson et al. in 1952. The peak age of incidence is between 15 and 35 years with slight sex predominance among women. The most common sites involved include extremities and trunk and in young adults and head and neck in children. ASPS is a slow-growing tumor with unusual patterns of metastasis which runs a poor prognosis. The aim of this article was to present a case of ASPS of retroperitoneal origin along with its diagnostic and therapeutic workups.
    Case Report: A 31-year-old patients with a chief complain of an abdominal mass in right lower quadrant, underwent surgical resection as a neuroendocrine tumor according to pre-operative imaging studies. Pathology reported the lesion as ASPS. The patient refused adjuvant chemotherapy and unfortunately he did not show up to continue his treatment and further follow-ups. A careful investigation would be required including clinical findings, clinicopathological correlation, with appropriate radiological studies, before definitive treatment of ASPS.
    Conclusions
    The main problem to gain an extended insight into clinical features and optimal treatment is the rarity of the disease. Given the ineffectiveness of current treatments in advanced ASPS, further future investigation to find new therapeutic options would be required.
    Keywords: Neoplasms, Peritoneum, Sarcoma, Alveolar soft part, Soft tissue neoplasms
  • Mostafa Mehrabi Bahar, Mohammad Reza Motie, Ahmad Amouzeshi, Hossein Razavian, Alireza Rezapanah, Elena Saremi
    Torsion of the gallbladder is a relatively rare surgical disease which mimics acute cholecystitis'' symptoms that usually would not be respondable to medical therapies. The torsion would mostly be diagnosed intra operatively. Cholecystectomy is the treatment of choice. In general in our centre, General Surgery department, Imam Reza hospital, Mashhad, Iran, since 1986 over 14000 cholecystectomies have been performed and 3 cases with an underlying cause of gallbladder torsion are documented. The relative literatures reviewed so then the presentation, paraclinical findings, and the treatment of gallbladder volvulus are discussed. Gallbladder volvulus: Review of the literature and report of three cases.
    Keywords: Gallbladder torsion, cholecystitis, cholecystectomy
بدانید!
  • در این صفحه نام مورد نظر در اسامی نویسندگان مقالات جستجو می‌شود. ممکن است نتایج شامل مطالب نویسندگان هم نام و حتی در رشته‌های مختلف باشد.
  • همه مقالات ترجمه فارسی یا انگلیسی ندارند پس ممکن است مقالاتی باشند که نام نویسنده مورد نظر شما به صورت معادل فارسی یا انگلیسی آن درج شده باشد. در صفحه جستجوی پیشرفته می‌توانید همزمان نام فارسی و انگلیسی نویسنده را درج نمایید.
  • در صورتی که می‌خواهید جستجو را با شرایط متفاوت تکرار کنید به صفحه جستجوی پیشرفته مطالب نشریات مراجعه کنید.
درخواست پشتیبانی - گزارش اشکال