mohammadreza sobhiyeh

The purpose of this study was to compare the effect of six-months of combined care program with garlic supplementation on coagulation factors (INR, PPT, PT) in middle-aged men with DVT. The present study was a quasi-experimental with a clinical trial design (code: IRCT20210718051924N1). Subjects were 40 men (age: 51.50 ±4.01 years, fat percentage: 28.63 ±3.24) with a history of at-least 3 years of DVT who were taking warfarin randomly divided into four groups: Combined-exercise, Combined-exercise +garlic, Garlic and Control. Combined-exercise for 24 weeks, 3 sessions per-week, first resistance training (50 to 60% 1RM) and then aerobic training (55 to 60% of the reserve-heart-rate). 1200mg daily garlic supplement was used in the form of capsules at ten o'clock in the morning. PT, PTT and INR factors were measured before and after 24 weeks. Two-way analysis of variance, paired t-test and Tukey post-hoc test were used (P<0.05). The results showed that both combined-exercise +garlic and consumption of garlic increased the PT (garlic 3.3%, p=0.004; exercise +supplement 13.3%, P=0.001) and INR (garlic 2%, p=0.013; exercise +supplement 46%, p=0.001) had a significant effect, also combined-exercise +garlic on the PTT 1.5% (p=0.014) had a significantly effect. But this wasn’t of effects in the combined-exercises (PT: p=0.355, INR: p=0.259, PTT: p=0.448) and the group Garlic was-not significant in PTT (p=0.504). It is recommended to use combined exercises with garlic consumption because of its effect on PT and INR and the important role of these factors in rebalancing homeostasis.

The ineffectiveness of hemodialysis fistulas causes high costs and increases mortality and morbidity rates. The efficacy of drug-coated balloon and nondrug-coated balloon in dysfunctional arteriovenous Fistula was evaluated over six month period.

In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.

The success rate of drug-coated balloon angioplasty versus plain balloon angioplasty in the efficacy of arteriovenous fistulas increased significantly (19 vs. 6 and 13 vs. 12, respectively, P<0.05). There is also a significant relationship between age and diabetes over the lifetime of the arteriovenous fistula. According to results, the efficacy of arteriovenous fistula in the elderly patients (>65 years) and the diabetes mellitus patients were lower than other risk factors causing end-stage renal disease.

According to the results of this study, the use of drug-coated balloons rather than non drug-coated balloon is more effective in the efficiency of arteriovenous artery fistula.

Right internal jugular vein catheterization is a way to establish a temporary dialysis vascular access. Arterial injuries including inadvertent arterial cannulation and/or arteriovenous fistula formation are one of the most clinically important complications of hemodialysis catheter placement. Endovascular management of these conditions is a promising treatment option, especially for aged and co-morbid patients. This report represents a case of internal jugular vein-subclavian artery fistula formed by inadvertently misplaced double lumen tunneled cuffed central venous catheter that was treated successfully with covered stent graft placement.

Carotid body is a highly-specialized organ located at the bifurcation of the common carotid artery and responsible for acute adaptation to hypoxia. The most common disease state of carotid body is its enlargement. Carotid body tumors (CBTs) are infrequent and slow growing tumors that must be considered in lateral neck mass evaluations.. In this study we aimed to review the clinical characteristics and management of CBTs in Shohadaye Tajrish Center during the last ten years (2002 - 2012).. This was a retrospective study in which the medical records of patients diagnosed with CBT during the past ten years (from April 1st 2002 to April 1st 2012) were reviewed. The hospital ethics committee approved the extraction of data. For data collection we used a structured questionnaire, designed in six categories: demographic data, life style and predisposing factors, symptoms upon presentation, imaging results, treatment, complications, and follow up. Selected junior residents were responsible for extracting the data from the medical records and fulfilling the forms.. Overall, 48 patients with 51 CBTs were included in the study. The CBTs were bilateral in 3 (6.25%) cases. The cardinal presentations of these cervical masses were unanimous in all patients; 6 (12.5%) had symptoms of cranial nerve palsy. All cases had surgeries, while 3 patients with UN resectable tumors regarding massive invasion to CCA, ICA, and ECA, were treated with radiation simultaneously. The follow-up period in surgically resected CBTs did not elucidate any cause for the recurrencies.. This study provided clinico-epidemiological data on patients with CBT, which could be useful for prompt diagnosis and appropriate work-up for patients and families with CBTs..

The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery. For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer. Patients and Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didnt, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo radiotherapy were also assessed. 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 (55%) underwent APR while 15(32%) and 6(13%) patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 (53%) underwent APR while 14 (25%) and 10 (18%) patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference (p=0.0001). Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors.

In candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical.. The present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications..Patients and Sixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests.. In the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen.. This study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods..

Jejunal diverticula have a prevalence of approximately 1% in the general population. Perforation of jejunal diverticulum is a rare. Clinically this diagnosis may be easily confused with other causes of an acute abdomen. In the article, we discuss a 74-year–old man with a 2-day history of constipation and left–sided abdominal pain. The day before admission he developed an abrupt exacerbation his symptoms with pain localized to periumbilical and left lower quadrant. An abdominal computed tomography scan revealed soft tissue stranding within the left upper quadrant, bilateral plural effusions, larger on the left, an opacity with the right and left pulmonary lobes and polypoid lesion with in stomach.Physical examination revealed left upper quadrant fullness. An emergency laparotomy was carried out. This revealed multiple jejunal diverticula, one of which had perforated 40 centimeters distal to the ligament of Treitz.

Cystic lymphangioma of the pancreas is extremely rare, accounting for less than 1% of pancreatic tumors. Though congenital, it can affect all age groups. Cystic lympangioma occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable epigastric mass. Complete excision is curative, even though, depending on the tumor location, surgery may be simple or involve extensive pancreatic resection and anastomoses. In this case report, we discuss a 63-year old patient who presented with epigastric pain and on investigation was found to have pancreatic head cystic lymphangioma. At surgery the tumor was completely excised, with preservation of pancreatic duct. Histology and immunohistochemistry confirmed cystic lymphangioma of the pancreas. This case highlights that a diagnosis of cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic lesions.

The complications of vascular access are the most imperative etiology for hospitalization, morbidity and mortality in chronic hemodialysis. The most prevalent complication of central catheter is dysfunction due to thrombosis. Aspirin is an anti-aggregative platelet drug that may increase the patency of permanent catheters (perm-cath).. The aim of this study was to evaluate the role of Aspirin in perm-cath survival..Patients and This study included a total of 185 ESRD cases according to the inclusion criteria for perm-cath insertion in hemodialysis. One hundred and eighty patients following perm-cath insertion had proper blood flow through perm-cath during hemodialysis. Patients were randomly divided between intervention (80 mg/day Aspirin initiated a day following catheter insertion) and control (placebo) groups. The average time that the perm-cath was functional was noted. Demographic characteristics included comorbidities and past history were also used to address probable influence on perm-cath function and patency.. The mean survival time of the catheter in Aspirin group was significantly higher than the control group (5.3 ± 4.7 month versus 3.9 ± 2.7 month, P = 0.012). No significant difference in major complications of Aspirin use (such as GI bleeding) was noted between two groups (P = 0.52). In terms of the patient’s demographic characteristics, those of the female gender and a history of diabetes mellitus were found to have significant influence on median survival rate of the catheters (P = 0.021, 0.043 respectively).. These results suggest that Aspirin use following perm-cath insertion might be beneficial for catheter survival. This increased survival time might enable patient’s use of AVF maturation for long term dialysis access..

Splenic artery aneurysms (SAAs) are rare (0.2-10.4%); however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.

A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.

It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

The marginal length from main tumor in esophageal cancer is a considerable issue regarding surgical management and adjuvant treatment; so we decided to study the contractility effect on the proximal surgical margin after immersing it in10% buffered formalin as a fixative. The proximal marginal length of ten sequential patients with esophageal cancer who underwent transhiatal esophagectomy were studied, on the operating table as fresh specimens, immediately after resection, and next 24, 48 and 72 hours after immersing in 10% buffered formalin. The contraction continued through the day 3, the mean contractility after one day was about 27%, after two days was 33% and after three days was 38%. This study shows how the proximal esophageal margin can vary by the time, after immersing in 10% buffered formalin and should be considered in every settings and reporting documents by pathologists.

Simultaneous a collision tumor of stomach consisting of adenocarcinoma and Gastrointestinal Stromal Tumor (GIST) is very rare based on our knowledge. This coexistence has rarely been reported in literatures.We report a case of 64-year-old woman who has diagnosed with prepyloric poorly-differentiated diffuse signet-ring cell type adenocarcinoma and has undergone an elective D2 total gastrectomy. During operation another mass in fundic body region has found.The pathologic examination of the mass has shown GIST. Immunohistochemical staining for CD117 and Desmin was positive whilst that for S100 was negative.This case reports the simultaneous two tumors development of different histotypes and natures in the same organ.

Dialysis vascular access complications are considered as significant causes of morbidity in chronic hemodialysis patients.. The aim of the present study was a comparison of axillary loop and straight grafts patency and its complications in hemodialysis access..Patients and In this cohort study conducted at Shahid Beheshti Medical University, 77 patients who underwent placement of loop or straight access grafts were included. Demographics, primary and secondary patency rates and complications like thrombosis, infection, bleeding, steal syndrome and other complications were compared in these two groups. The collected data was analyzed by chi-square test, t-test, and logistic regression.. Primary patency rate in straight and loop groups after 1 month were 88.9% and 92.3% respectively (P = 0.721), and after 24 months were 31% and 55.5% respectively (P = 0.058). Secondary patency rate in straight and loop groups after 3 months were 75.6% and 92.3% respectively (P = 0.189), and after 24 months were 37.9% and 66.7% respectively (P = 0.044). The frequency of complications were the same among two methods of graft replacement and mal incidence of thrombosis, infection, delayed infection, pseudoaneurysm formation and steal syndrome occurrence ultimate graft failure and venous hypertension were not significantly different (P > 0.05).. Polytetrafluorethylene (PTFE) vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, there was no significant difference between the two groups for complications and early patency, but late patency was improved in loop group. More study is necessary for a conclusive assessment.

Pseudoaneurysms (PSA) of deep femoral artery (DFA) have been reported following penetrating and blunt trauma to the thigh and orthopedic procedures of the proximal femur. We describe a case of pseudoaneurysm of DFA as a late complication of limb trauma which was confirmed by exploration in an urgent surgery. After two operations successful surgical repair was performed.

To report a novel technique for arteriovenous fistula (AVF) closure in side-to-side fistulas. One hundred and sixty-two patients with sideto- side AVFs, who were candidates for AVF closure, were randomly divided into two groups: group A (84 patients) who underwent AVF ligature and group B (78 patients) who underwent AVF closure using transvenous endovenorrhaphy technique. Both procedures were conducted by the same surgical team. The patients were followed up for 6 months. Of 124 patients with proximal AVFs, 65 (52%) subjects underwent ligation and 59 (42%) transvenous endovenorrhaphy. Of 38 patients with distal AVFs, half underwent ligation and for the remainder, transvenous endovenorrhaphy was done. Failure of AVF closure was detected in 28 (17%) patients; 25 (89.28%) were in group A and 3 (10.71%) were in group B. All of these recurrences were successfully treated by transvenous endovenorrhaphy technique. We claim that significant lower failure rate of transvenous endovenorrhaphy makes it the technique of choice, especially for side-to-side AVFs.

Many patients with inguinal hernia are operated and hemovac is used to drain extra fluids from the surgery site. In this study, we compared the results of surgery in patients operated with hemovac vs. who had not hemovac. In a randomized clinical trial, 86 patients with inguinal hernia were assigned into two groups. Patients were operated by Lichtenstein method and hemovac was used in one group. The short- term outcome was compared between two groups. Severity of pain in hemovac group was mild in 0 cases, moderate in 6 and severe in, and in non hemovac group was mild in 9 cases, moderate in 0 and severe in. Severity of scar in hemovac group was mild in cases, moderate in 0 and severe in, and in non hemovac group was mild in cases, moderate in 6 and severe in. Inflammation in hemovac group was mild in, moderate in 0 and nobody had severe inflammation, while in non hemovac group was mild in cases, moderate in and severe in. There were no significant differences in pain, scar and inflammation among groups with and without hemovac. Using hemovac in inguinal hernia repair does not have effect on the healing of surgery site

Gallstone disease is one of the most common gastrointestinal diseases requiring surgery with probable postoperative infection. The role of prophylactic antibiotics (AB) in prevention of infection is controversial. This study aimed to compare the manifestations, complications and outcomes of two groups of patients, those receiving prophylactic AB versus placebo, in order to determine whether antibiotic therapy is required.Patients and In this double blind randomized clinical trial, we studied 130 patients with symptomatic cholelithiasis or polyps of gallbladder admitted in Shohada-e-Tajrish Hospital, Tehran, Iran for cholecystectomy between 2006 and 2008. Patients were randomly assigned in two subgroups: the first group received 1gr ceftriaxone during induction of anesthesia and the second group received 10mL of isotonic sodium chlorides solution as placebo. All patients were followed for 4 weeks after surgery. The study population included 61 males and 69 females with the mean age of 49.3±9.6 and 51.8±9.9 years in treatment and placebo group, respectively. Of 130 bile culture results, 83 were negative. Escherichia coli, Klebsiella and Staphylococcus aureus were the most common cultured bacteria. There was no statistically significant difference in culture results between the patients received AB and placebo (NS). The surgical technique (open versus laparoscopic) did not influence the culture results. It can be concluded that prophylactic antibiotics do not have any preventive effect on wound infection in a double blind setting. According to our findings, routine antibiotic prophylaxis as recommended for biliary surgery (open or laparoscopic cholecystectomy) is now questionable.

To determine the co-incidence of gallstones with upper GI disease in patients who were candidate for elective cholecystectomy. Typical pain of gallstones frequently cause special pattern which can usually be distinguished from symptoms of other organic and functional diseases. But patient with cholelithiasis and atypical pattern of abdominal pain seems to bring about a challenging clinical problem to the surgeon.Patients and We designed a retrospective study to evaluate clinically and pathologically 360 patients whom were presented to Shohadaye Tajrish hospital with sonographic documented gallstones which were selected for elective cholecystectomy by the surgeon. They have also undergone esophagogastroduodenoscopy (EGD) before their cholecystectomy operation as a part of their routine preoperational evaluations, between April 2001 and March 2006.Endoscopic examination was performed for all treated patients 1 to 4 days before their operations. Among these 360 patients, 178 patients (49.4 %) experienced atypical abdominal pain, the other 182 patients (50.6 %) presented with typical abdominal pain. These two groups were comparable in sex and age. From those with typical pattern of pain, only one had positive findings in EGD (0.54 %) while among the 178 patients with atypical pain, 148 (83 %) had abnormal findings in EGD (p<0.001). The surgery was postponed for patients with ulcer, and anti ulcer treatment was started. In 16 patients, the symptoms associated with colelithiasis subsided after healing of the ulcer. Of 178 patients with atypical pain, 11 cases (6 %) exhibited evidences of malignancy in their upper gastrointestinal (GI) pathology. Cholelithiasis in these two last patients was incidental finding, and a cholecystectomy was not performed. Because of higher incidence of concurrent upper GI problems in patients with gallstones and atypical abdominal pain, esophagogastroduodenoscopy prior to elective cholecystectomy in this group of patients could be clinically helpful and also may be cost effective.

Hydatid cyst mostly presents solitary cyst in right lobe of liver. It is asymptomatic and patient presents with pressure effects or rupture of cyst. Case Report: We introduce a patient who was referred to the emergency room with history of blunt trauma and symptoms of abdominal pain and generalized severe pruritus without anaphylaxis and urticaria. Explorative laparotomy showed a ruptured hydatid cyst. Albendazole 400 milligram was prescribed twice a day for 4 weeks after operation. The patient discharged with healthy appearance. There was no abnormal findings in further follow-up visits.