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Peritoneum

در نشریات گروه پزشکی
  • Hamidreza Haghighatkhah, Seyedeh Mahdieh Ghasimi, Afshin Moradi, Seyed Soran Ghafouri, Tayeb Hosseini
    Introduction

    Endometrial stromal sarcoma (ESS) is an uncommon condition that accounts for approximately 0.2% of all reproductive tract malignancies. Among the various subtypes of ESS, low-grade extrauterine endometrial stromal sarcoma (LG-EESS) is even rarer and has only been reported in a limited number of case studies.

    Case Presentation

    We reported a case of LG-EESS in a 35-year-old woman with a five-year history of stage IV endometriosis. The patient presented with chronic abdominopelvic pain and dysmenorrhea. Transvaginal ultrasound showed bilateral tubo-ovarian complexes with multicystic structures, while MRI revealed solid lesions with T1 iso signal, T2 hypersignal, and diffusion restriction, indicating metastatic implantation extending to the peritoneum and subhepatic region. A core needle biopsy confirmed LG-EESS, and immunohistochemistry showed CD10 positivity, aiding in the diagnosis and distinguishing it from other tumors.

    Conclusions

    Our case highlights the potential utility of preoperative diagnostic imaging, particularly MRI, in the evaluation of LG-EESS. Additionally, it emphasizes the importance of considering the possibility of extrauterine ESS, as this tumor exhibits histopathological features and clinical behavior similar to its uterine counterpart.

    Keywords: Endometriosis, Low Grade Extrauterine Endometrial Stromal Sarcoma, Peritoneum, Magnetic Resonance Imaging
  • Elham Barahimi, Zahra Ghaeini Hesarooeyeh, Ayoub Basham*, Mohadeseh Karimi, Behnoush Heidari
    Background

    The simultaneous involvement of the pleura and peritoneum with tuberculosis in the absence of pulmonary foci is an uncommon condition that may lead physicians to misdiagnose.

    Case Presentation

    Herein, we present a Persian male adult who manifested with epigastric pain, weakness, and a history of pleuritic chest pain two months prior to admission. The findings of the physical examination included vital signs within the normal range, unilateral fine crackle in the lung, abdominal distension with positive shifting dullness, and fluid wave test. Analysis of the ascitic fluid revealed a Serum-ascites albumin gradient (SAAG) of less than 1.1g/dl, indicating a non-portal condition. The results of the acid-fast bacilli (AFB) staining as well as the TB polymerase chain reaction (PCR) test were negative. However, the adenosine deaminase (ADA) level was 44 IU/L. A chest CT scan revealed mediastinal lymph node enlargement and pleural thickening with loculated pleural effusion. Three acid-fast bacilli smear of morning sputum were sent, and all three were negative. An abdominopelvic CT scan showed multiple periaortic and mesenteric lymph nodes of varying sizes with mesenteric haziness and accumulation of effusion in the peritoneal cavity. Eventually, peritoneal biopsy, the gold standard, was performed, which revealed multiple granulomatous lesions and areas of caseous necrosis surrounded by Langerhans giant cells and epithelioid cells.

    Conclusion

    It is worth noting that in cases of ascites and pleural thickening, especially in patients with poor socioeconomic status, simultaneous pleural and peritoneal TB should be considered, especially in third-world countries.

    Keywords: Extrapulmonary, Tuberculosis, Pleural Effusion, Ascites, Pleura, Peritoneum, Case Report, Literature Review
  • رضا حسین پور، سعادت محرابی، شکوفه نیکوئی، شیروان سلامی نیا، محمدباقر جهانتاب، چمران ذکریا نژاد کاسگری *
    زمینه و هدف

    آپاندیسیت شایع ترین وضعیت جراحی اورژانسی است. از عوارض پس از جراحی آپاندکتومی می توان به عوارض پوستی، عفونت، درد پس از عمل و فتق و انسداد اشاره کرد. بین جراحان بر سر بستن صفاق بعد از عمل های جراحی شکمی تفاوت نظر وجود دارد. لذا هدف از این مطالعه تعیین و تاثیرترمیم یا عدم ترمیم پریتوین بر عوارض پس از آپاندکتومی باز بود.

    روش بررسی

    این یک مطالعه کارآزمایی بالینی می باشد که در سال 13991398در بیمارستان شهید بهشتی یاسوج بر روی 126 نفر از بیماران مراجعه کننده که شرایط ورود به مطالعه جهت انجام جراحی آپاندکتومی به روش باز را داشتند، انجام گرفت. در این مطالعه تصادفی سازی به روش سیستماتیک انجام گرفت. مشاهدات بالینی و پیگیری بیماران یک هفته، سه ماه و شش ماه پس از عمل جراحی انجام شد. داده های جمع آوری شده با استفاده از آزمون های آماری آنالیز واریانس، تی تست و مجذور کای تجزیه و تحلیل شدند.

    یافته ها

    از 126 نفر کاندید برای عمل جراحی آپاندکتومی، 60 نفر مرد و 66 نفر زن بودند. در این میان 64(8/50 درصد) نفر تحت عمل جراحی همراه با ترمیم پریتوین و 62 نفر(2/49 درصد) تحت جراحی بدون ترمیم پریتوین قرار گرفتند. میانگین سنی این جمعیت 82/13±88/26 سال بود و در محدوده بین 5 تا 65 سال قرار داشت .نتایج نشان داد که هم در گروه با ترمیم پریتوین و هم در گروه بدون ترمیم پریتوین، 62 نفر(9/69 درصد) بدون عفونت و 2 نفر(1/3 درصد) همراه با تخلیه چرکی، علایم عفونت وعفونت محل جراحی(SSI) بودند. هم چنین در گروه با ترمیم پریتوین، 42 نفر(6/65 درصد) بدون درد، 16 نفر(0/25 درصد) میزان درد خفیف و 6 نفر(4/9 درصد) میزان درد متوسط داشتند. در گروه عدم ترمیم پریتوین 50 نفر(6/80 درصد) بدون درد، 11 نفر (7/17 درصد) درد خفیف و 1 نفر(6/1 درصد) درد متوسط داشتند. بین دو گروه عمل جراحی آپاندکتومی با ترمیم پریتوین و بدون ترمیم پریتوین، در وجود عفونت، فتق و انسداد و هم چنین شدت درد اختلاف معنی داری مشاهده نشد(076/0=p)، اما وجود درد در بیماران بدون ترمیم پریتوین به طور معنی داری کمتر بود(044/0=p).

    نتیجه گیری

    نتایج به دست آمده از این مطالعه نشان داد که استفاده از دو برش جراحی پریتوین باز و پریتوین بسته در عمل جراحی آپاندکتومی در مولفه های عفونت محل زخم تفاوت معنی داری باهم نداشتند، مولفه فتق اینسیژنال بعد از یک سال مشاهده نشد، هم چنین در مقایسه مولفه درد پس از عمل مشاهده شد که درد در گروه پریتوین باز کمتر است، لذا در بیماران با تشخیص آپاندیسیت پیشنهاد می شود از روش جراحی آپاندکتومی بدون ترمیم پریتوین استفاده شود.

    کلید واژگان: آپاندکتومی، ترمیم پریتوئن، آپاندیس، صفاق، عوارض پس از جراحی
    R Hosseinpour, S Mehrabi, SK Nikooei, SH Salaminia, MB Jahantab, CH Zakaria Nezhad Kasgari *
    Background & aim

    Appendicitis is the most common condition of emergency surgery. Complications after appendectomy include skin complications, infection, postoperative pain, hernia and obstruction. There is a difference of opinion among surgeons on peritoneal repair after abdominal surgery. Therefore, we aimed here to evaluate the effect of peritoneal repair versus non-repair in appendectomy patients in terms of postoperative complications.

    Methods

    The present clinical trial study that was conducted on 126 patients who underwent open appendectomy at Shahid Beheshti Hospital of Yasuj, Iran, from 2019 to 2020 who had the inclusion criteria. In the present study, randomization was performed systematically. Clinical observations and follow-up of patients was one week, three months and six months after surgery. After collecting and forming the data file in the computer, the information was analyzed using descriptive analytical statistics (including frequency distribution table, analysis of variance, T-test, chi-square) through SPSS software.

    Results

    Out of 126 candidates for appendectomy, 60 were male and 66 were female. Among them, 64 (50.8%) underwent surgery with peritoneal repair and 62 (49.2%) underwent surgery without peritoneal repair. The mean age of this population was 26.88 13 13.82 years and ranged from 5 to 65 years. The results indicated that in both the peritoneal repair and non-peritoneal repair groups, 62 patients (69.9%) had no infection and 2 patients (3.1%) had purulent drainage, symptoms of infection, and SSI. Moreover, in the group with peritoneal repair, 42 patients (65.6%) had moderate pain, 16 patients (25.0%) had mild pain and 6 patients (9.4%) had moderate pain. In the non-peritoneal repair group, 50 patients (80.6%) had no pain, 11 patients (17.7%) had mild pain and 1 patient (1.6%) had moderate pain. There was no marked difference between the two groups of appendectomy with peritoneal repair and without peritoneal repair, in the presence of infection, hernia and obstruction, as well as pain intensity, but the presence of pain in patients without peritoneal repair was significantly less.

    Conclusion

    The results of the present study revealed that the appendectomy surgical methods, including open and closed peritoneum, did not indicate a significant difference for wound site infection. On the other hand, the amount of postoperative pain was lower in the open peritoneum group. Therefore, it is suggested to use appendectomy without peritoneal repair in patients with appendicitis.

    Keywords: Appendectomy, Peritoneal repair, Appendix, Peritoneum, Postoperative complications
  • Ahtesham Khizar*, Soha Zahid

    Background and Importance: 

    Ventriculoperitoneal shunt surgery is a widely accepted treatment for hydrocephalus, but it is not free from complications. Of all the complications, bowel perforation represents only 0.01-0.07% and it often presents with asymptomatic anal protrusion of the distal end of the ventriculoperitoneal shunt. The mechanism causing shunt ejection is unknown, but the most widely accepted theory is that after intestinal perforation, the tubing of the shunt is propelled out by the peristaltic movements in the gut.

    Case Presantation: 

    A case of a 3.5-year-old boy with anal protrusion of the peritoneal end of ventriculoperitoneal shunt and multiple brain abscesses is reported. In surgery, the ventriculoperitoneal shunt was divided at the clavicular region, and the peritoneal end was gently pulled out of the anus while the ventricular end was exteriorized. Empirical antibiotics, antiepileptics, and steroids were given. The culture and sensitivity report revealed no microorganisms. The child improved over a period of two weeks and then a new ventriculoperitoneal shunt was inserted on the opposite side.

    Conclusion

    Suspicion for bowel perforation must be kept high in symptomatic ventriculoperitoneal shunt patients even though most of the patients present with asymptomatic anal protrusion of the peritoneal end of ventriculoperitoneal shunt. In order to avoid infectious and neurological consequences, early identification and then subsequent treatment are crucial. The extruded end can easily be removed from the migrated orifice without the need for extensive surgery.

    Keywords: Anal canal, Peritoneum, Ventriculoperitoneal shunt, Brain abscess
  • Arash Mohammadi Tofigh *, Mohammad Hossein Jafarzadeh
    Background

    There is no consensus regarding closure or non-closure of peritoneum in laparotomy, and this topic remains a controversy among surgeons.

    Objectives

    This clinical trial aimed to compare short-term and long-term benefits of peritoneal closure with non-closure in an academic medical center.

    Methods

    In this double-blinded two-arm parallel-group randomized trial, 124 patients undergoing laparotomy with midline incision were assessed from March 2019 to September 2019 at Imam Hossein Medical Center, Tehran, Iran. We used the Rand function of the Excel software to randomly assign 62 patients to the peritoneal closure group and 62 patients to the non-closure group. The patients were evaluated for short-term complications including wound-related fever, infection, need for analgesics, pain in the first 2, 6, 24, and 48 hours postoperatively according to the Visual Analogue scale (VAS), duration of hospitalization, as well as long-term complications including incisional hernia and intraperitoneal adhesion one year after the surgery. Statistical analysis was carried out with SPSS version 22 software.

    Results

    The non-closure peritoneum group had a lower rate of wound-related fever, infection, and analgesic need than the peritoneal closure group, but these differences were not statistically significant (P = 0.488, P = 0.455, and P = 0.062, respectively). The adhesion rate and incisional hernia incidence one year after the surgery were not significantly different between the two groups (P = 0.363, P = 0.586). Pain intensity was significantly lower in the non-closure group than in the closure group in the first two, six, and 24 hours (P = 0.008, P = 0.004, and P = 0.047, respectively) but not significantly at 48 hours (P = 0.146).

    Conclusions

    Peritoneum closure after non-emergency, non-infected laparotomy increases the postoperative pain while it has no benefit for long-term complications like incisional hernia or intra-peritoneal adhesion.

    Keywords: Laparotomy, Peritoneum, Complications, Pain
  • Nahla Kechiche *, Dorsaf Makhlouf, Rachida Lamiri, Arije Zouaoui, Lassaad Sahnoun, Mongi Mekki, Mohssen Belguith, Abdellatif Nouri

    Peritoneal hydatid cysts are rare in children even in endemic areas. The primary or secondary origin of this site remains controversial, especially in children. Secondary peritoneal hydatid cysts are mainly the result of spontaneous or traumatic rupture of concomitant liver cysts or the leakage of cystic content during surgery. The purpose of our study is to present the largest case series of peritoneal hydatidosis in children. In addition, we aimed to assess the clinical and paraclinical findings as well as the management of echinococcosis at this location in children. The present case series is a study of ten children with peritoneal hydatid cysts, who underwent surgical intervention between 2013 and 2018 in the Pediatric Surgery Department, University of Monastir (Monastir, Tunisia). The mean age of the children was six years. All children presented abdominal pain, and underwent ultrasonography and contrast-enhanced computed tomography of the abdomen. Two patients had been operated on for lung hydatid cysts six months prior to the study. In two cases, radiologic investigations revealed the presence of an uncomplicated hepatic hydatid cyst located in segments II and IV. All patients underwent surgery, of which four underwent laparoscopy. Post-surgery, all patients received albendazole for three months, and the follow-up period was uneventful. Currently, all patients are in good health. Peritoneal hydatid disease is frequently secondary to the rupture of a primary hepatic cyst. Diagnosis is performed by abdominal ultrasound, computed tomography, and a positive serology result. Open or laparoscopic excision can be combined with medical treatment.

    Keywords: Child, Echinococcosis, Peritoneum
  • Mahsa Abbaszadeh*, Mohammadreza Salehi, Mohammad Shirkhoda, Sahar Karimpour Reyhan

    Tuberculosis (TB) could be presented with different manifestations. On many occasions, further evaluation in patients with the first diagnosis of the lung, pancreas, ovarian, or bladder cancer leads to the definite diagnosis of TB and the symptoms subside by treatment. Concerning the easy access to diagnostic tests and dramatic treatment responses, it is essential that physicians in endemic areas consider TB in patients with suspicious symptoms and in the differential diagnosis of malignancies, to diagnose the disease sooner and by simple and inexpensive tests; thus, avoiding imposing extra expenses to patients and the health system. We reported a 45 year-old female who was evaluated for abdominal pain, significant weight loss, and ascites for the past 4 months. The mediastinal and abdominopelvic Computed Tomography (CT) scan was performed in the initial evaluations of the patient. Accordingly, massive para-aortic and mediastinal lymphadenopathies and two thyroid nodules were detected. Furthermore, considering peritoneal thickening and moderate ascites, lymphoproliferative disorders were highly suggested as the diagnosis. The laboratory test data revealed bicytopenia, Erythrocyte Sedimentation Rate (ESR:57), and a high Cancer Antigen 125 (CA125). Unfortunately, the results of paracentesis were unavailable, though cytology was negative for malignancy. Due to anemia and weight loss, endoscopy and colonoscopy were performed twice in two different clinics, of which only gastritis was reported. Multiple abdominal and vaginal sonography was performed; these assessments suggested mild splenomegaly, mesenteric engorgement and thickening, multiple para-aortic and iliac adenopathies, as well as healthy uterus and ovaries. At the beginning of admission in Imam Khomeini Hospital, the patient denied any relevant medical history or family history. With further detailed questioning, we noticed a positive TB history in the patient’s grandmother, who lived with her. A Purified Protein Derivative (PPD)

    Keywords: Tuberculosis, Peritoneal tuberculosis, Peritoneum, Ascites, Unnecessary services, Health economics
  • Leila Mirzaeian, Farideh Eivazkhani, Maryam Hezavehei, Ashraf Moini, Fereshteh Esfandiari, Mojtaba Rezazadeh Valojerdi, Rouhollah Fathi
    Objective

    Decellularized tissue scaffolds provide an extracellular matrix to control stem cells differentiation toward specific lineages. The application of mesenchymal stem cells for artificial ovary production may enhance ex vivo functions of the ovary. On the other hand, the scaffold needs interaction and integration with cells. Thus, the development of ovarian engineered constructs (OVECs) requires the use of efficient methods for seeding of the cells into the ovarian and other types of scaffolds. The main goal of the present study was to develop an optimized culture system for efficient seeding of peritoneum mesenchymal stem cells (PMSCs) into human decellularized ovarian scaffold.

    Materials and Methods

    In this experimental study, three methods were used for cellular seeding including rotational (spinner flask) and static (conventional and injection) seeding cultures. OVECs were evaluated with Hematoxylin and Eosin staining and viability analyses for the seeded PMSCs. Then, immunohistochemistry analysis was performed using the best method of cellular seeding for primordial germ cell-like cells, mesenchymal stem cells and proliferation markers. Stereology analysis was also performed for the number of penetrated cells into the OVECs.

    Results

    Our results showed that rotational seeding increases the permeability of PMSCs into the scaffold and survival rate of the seeded PMSCs, comparing to the other methods. On the other hand, rotationally seeded PMSCs had a more favorable capability of proliferation with Ki67 expression and differentiation to ovarian specific cells with expression of primordial germ cell line markers without mesenchymal stem cells markers production. Furthermore, stereology showed a more favorable distribution of PMSCs along the outer surfaces of the OVEC with further distribution at the central part of the scaffold. The average total cell values were determined 2142187 cells/mm3 on each OVEC.

    Conclusion

    The rotational seeding method is a more favorable approach to cell seeding into ovarian decellularized tissue than static seeding.

    Keywords: Mesenchymal Stem Cells, Ovary, Peritoneum, Seeding, Tissue Engineering
  • رضا حکمت*، پریا افراز
    مقدمه 

    با توجه به اهمیت روزافزون دیالیز صفاقی و با در نظر گرفتن احتمال وجود ویژگی‎های خاص در نزد بیماران دیالیزی در هر منطقه جغرافیایی و با خاستگاه قومی و وضعیت فیزیکی خاص آن بیماران ، تعیین این ویژگی ها حائز اهمیت می‎باشد.

    روش کار

    در این مطالعه وضعیت قدرت انتقال پرده صفاق با استفاده از انجام تست PET(Peritonealequilibrationtest) در چهل بیمار دیالیز صفاقی مزمن از نوعcontinuous ambulatory peritoneal dialysis)  CAPD (بیمارستان قائم (عج)، در شروع دیالیز صفاقی  بررسی شده است.

    نتایج 

    نتایج حاکی از آن است که  از چهل بیمار دیالیز صفاقی ، در 90% بیماران در شروع دیالیز صفاقی بر اساس نتایج حاصل از تستPET، پرده صفاق از نوع با قدرت انتقال بالا و یا با قدرت انتقال متوسط رو به بالا می باشد، و تنها 10 درصد بیماران دیالیز صفاقی مزمن در شروع دیالیز پرده صفاق با قدرت انتقال متوسط  داشتند.این نسبت  با امار ذکر شده در کتب مرجع و ماخوذه از سایر نقاط  ،که درصد نوع با قدرت انتقال بالا و یا با قدرت انتقال متوسط رو به بالا، حدود 50 -55%، در شروع دیایز صفاقی مزمن بوده، مغایر است. نتیجه گیری به کارگیری یک  ضریب اصلاح گلوکز واحد  قدیمی و فاقد  دقت و صحت لازم، همراه با  خطای  باقی مانده قابل توجه و سیستماتیک، محتمل ترین توجیه این میزان بالا از نا همخوانی  می‎تواند باشد. نسبت ترقیق گلوکز و کراتینین، مشخصات مایع دیالیز صفاقی، نوع دستگاه آنالیزر و روش اندازه‎گیری کراتنین نمی‎توانند عامل این ناهمسانی باشند. تاثیر عوامل جمعیتی و قومی تنها میتواند توجیه گر حدود 8% این تفاوت بارز باشند.

    کلید واژگان: پریتوئن، دیالیز صفاقی، قدرت انتقال، قند، کراتینین، سازمان‎ها
    Reza Hekmat *, Paria Afraz
    Introduction

    As evaluation of peritoneal membrane function is important in prescribing and choosing the kind of peritoneal dialysis and probability of difference in peritoneal membrane  characteristics among patients belonging to different geographical areas and different ethnic origin, also the possible impact of the type of transportation on patient survival,  we used peritoneal equilibration test (PET) to determine the kind of peritoneal membrane transportation at the start of dialysis.

    Materials and Methods

    Forty  CAPD (continuous ambulatory peritoneal dialysis)patients, (30 males and10 females,  with a mean age of 38 ± 14 years) attending Ghaem hospital, Mashhad, Iran, between October 2004 and October 2018, entered in to this study and underwent a 4.25% glucose, PET test.

    Results

    The obtained result showed that about 90% of patients were high or high average transporters. The results were completely different from  the results reported from other world’s peritoneal dialysis centers, which have reported between 35 to 55 percent of high or high average transporters among chronic peritoneal dialysis patients. Using a glucose correction factor formula, proposed by Twardowski, about thirty years ago, which only partially resolves the accuracy and precision problems, is the probable cause of this disparity.

    Conclusion

    In our center, about 90% of chronic peritoneal dialysis patients on CAPD, at the start of dialysis, were high or high average transporters. These results are in complete discordance with results reported in  medical literature or from other parts of the world. Using an outdated, glucose correction factor, with significant  residual error may be the source of this discrepancy.

    Keywords: Continuous Ambulatory Peritoneal Dialysis, Creatinine, Peritoneum, Peritoneal dialysis, Glucose, transportation
  • Alina Vitalievna Gerashchenko, Tatyana Grygorievna Filonenko, Elena Petrovna Golubinskaya, Margarita Alexeevna Kalfa, Maxim Andreevich Kriventsov *
    Leiomyomatosis peritonealis disseminata (LPD) is a benign disease characterized by the presence of multiple small nodules on the omentum, parietal, and visceral peritoneum. It corresponds to leiomyoma and often resembles metastases of malignant tumors; however, with favorable prognosis. Here we describe a 46-year-old woman, diagnosed with LPD, to demonstrate the etiopathogenesis of the developed leiomyomatosis following endoscopic extirpation of the uterus with the use of a power morcellator. The patient was operated for diffuse leiomyoma using a power morcellator. Six months later, during a follow-up visit, disseminated tumor nodes on the peritoneum were revealed. Histological and immunohistochemical (smooth muscle α-actin, vimentin, estrogen receptors, progesterone receptors, and Ki67) study confirmed the diagnosis of LPD. As part of the follow-up, certain regression of the tumor nodes was noted against the backdrop of the onset of menopause and the corresponding decline of estrogen levels. Currently, the prognosis is favorable and follow-up is ongoing. Such cases are rare, but the condition is particularly important due to its iatrogenic nature. It has attracted the attention of the Food and Drug Administration (FDA) because power morcellation is probably associated with the risk of spreading suspected cancerous tissue. The existing high risk of iatrogenic LPD formation indicates the need for detailed reporting of all similar clinical cases, including the established pathogenetic and pathomorphological mechanisms of this process to prevent morcellator-related complications.
    Keywords: Leiomyomatosis, Peritoneum, Iatrogenic disease
  • Bita Geramizadeh
    Hydatid disease (HD) is caused by Echinococcus granulosus and is endemic in many parts of the world. This parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most frequently targeted organs. Peritoneum, omentum, and mesentery are among these unusual locations, which can cause diagnostic challenge and treatment delay. This review provides information on the reported cases of the peritoneal, omental, and mesenteric hydatid cyst in the world during the last 20 years. During the last 20 years, there have been 49 published cases of hydatid cysts in the peritoneum, mesentery, and omentum. Among the reported cases in the English literature, the most common presenting symptom has been chronic abdominal pain and the method of primary diagnosis has been ELISA and ultrasonography. The best treatment modalities have been surgical excision, with and without adjuvant therapy, with albendazole and scolicidal agents. The published follow-up studies showed a low recurrence rate.
    Keywords: Hydatid cyst, Peritoneum, Omentum, Mesentery
  • Morteza Safi, Isa Khaheshi *, Mehdi Memaryan, Mohammadreza Naderian
    We present a 65-year-old man who developed retrosternal compressive chest pain. A 12-lead electrocardiography demonstrated ST-segment elevation in leads II, III and aVF. Emergent coronary angiography showed significant thrombus in the distal portion of the left main coronary artery. Abdomino-pelvic computed tomography scan, which was performed the next day, confirmed a pancreatic mass with peritoneal seedings, compatible with peritoneal carcinomatosis. This case underscores the importance of malignancies that may lead to a catastrophic ST-elevation myocardial infarction due to a hypercoagulable state and following thrombosis in the left main coronary artery.
    Keywords: Myocardial Infarction, Dyspepsia, Pancreatic Neoplasms, Peritoneum
  • 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
  • Hessam Ghassemof, Reza Jafarzadeh Esfehani
    Introduction
    Hydatid disease can involve various body organs, but it is less common for it to involve multiple organs simultaneously. Hydatid cysts present unique manifestations in each organ. Some of these manifestations are rarely reported. In this report, we discuss a case of hydatid disease of the liver and omentum. Although most of the abdominal hydatid cysts are considered to be asymptomatic, our patient presented with symptoms of acute abdomen due to a torted peritoneal cyst, which is a very rare presentation..
    Case Presentation
    A 40-year-old man was referred to the emergency department with dull and intermittent periumbilical pain in the left and right lower quadrant regions accompanied by moderate tenderness and rebound with involuntary guarding over the entire lower half of the abdomen. As the patient’s condition and abdominal pain were worsening rapidly, an open laparotomy was scheduled with the primary suspicion of peritonitis. During the surgery, five omental cysts were observed within different parts of the abdomen. One of the cysts was torted. Two simple cysts were also detected on post-operative abdominal computed tomography..
    Conclusions
    It is important to keep in mind that even peritoneal involvement may be seen despite intact hepatic cysts. Careful excision of these cysts is the treatment of choice..
    Keywords: Echinococcosis, Peritoneum, Acute Abdomen
  • Saman Nikeghbalian, Homeira Vafaei, Farid Moradian, Kourosh Kazemi, Nader Tanideh, Leila Shayan, Zahra Nikeghbalian
    Objectives
    To investigate the effects of intravenous infliximab in preventing the formation of peritoneal adhesions in an animal model of rat.
    Methods
    This was an experimental study being performed in animal laboratory of Shiraz University of Medical Sciences during 2012. Sixty albino rats were randomly assigned in to three groups by Random Design Method. The first group received single infliximab injection (n=20), the second one received double infliximab injection (n=20) and the third received nothing (n=20), after receiving intra-peritoneal injection of talc for induction of peritoneal adhesions. All the animals were sacrificed after 6 weeks and the peritoneal adhesions were evaluated according to Nair classification.
    Results
    We observed that the mean adhesion grade was lower in those who received double dose of infliximib when compared to single dose and controls. However the difference did not reach a significant value (p=0.178). The grade of peritoneal adhesion was also comparable between the three study groups (p=0.103). The mean number of 1st WBC count was also comparable between three study groups (p=0.382). We observed that 2nd WBC count was also comparable between two study groups (p=0.317).
    Conclusion
    Administration of intravenous infliximab after intraabdominal surgicalprocedures would not prevent the formation of peritoneal adhesions in animal model of albino rat.
    Keywords: Postoperative, Tissue adhesions, Peritoneum, Infliximab, Animal models, Rats
  • صنم مرادان، راهب قربانی، مرضیه اسلامی موید
    مقدمه
    جهت انجام عمل سزارین، روش های متنوعی تعریف شده است که هر یک پیامدهای متفاوتی دارند. برخی موافق بستن صفاق در عمل سزارین هستند و گروهی دیگر از بازگذاشتن آن حمایت می کنند. با توجه به اختلاف نظرهای موجود در این زمینه، مطالعه حاضر با هدف مقایسه برخی پیامدهای کوتاه مدت دو روش بستن و بازداشتن صفاق در عمل سزارین انجام شد.
    روش کار
    این مطالعه کارآزمایی بالینی دوسویه کور می باشند که از مهر ماه سال 1390لغایت آذر ماه سال1391 بر روی 80 زن باردار ترم که جهت انجام اولین سزارین الکتیو به بیمارستان امیرالمومنین (ع) سمنان مراجعه کرده بودند، انجام شد. بیماران به صورت تصادفی در دو گروه بستن (گروه شاهد) و باز گذاشتن صفاق (گروه مطالعه) قرار گرفتند. همه بیماران با روش اسپانیال تحت بی حسی قرار گرفته و توسط یک جراح عمل شدند. میزان درد در 24 ساعت اول پس از عمل بر اساس معیار VAS، میزان دوز مصرفی دارو های ضد درد، زمان اولین دفع بیمار بعد از عمل و همچنین میزان عفونت زخم در یک هفته اول در گروه ها ثبت و مقایسه شد. تجزیه و تحلیل داده ها با استفاده از نرم افزار آماری SPSS (نسخه 16) و آزمون های کای اسکوئر، من ویتنی، ویلکاسون و تی و آنالیز واریانس با اندازه گیری مکرر انجام شد. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.
    یافته ها
    روش بازگذاشتن صفاق جداری و احشایی به صورت معنی داری در کاهش درد بعد از سزارین (001/0>p)، نیاز به داروی ضد درد (012/0=p) و زمان کمتر تخلیه روده (001/0=p) نسبت به بستن آنها ارجحیت داشت. بروز عفونت زخم در بین دو گروه تفاوتی نداشت(1=p).
    نتیجه گیری
    روش بازگذاشتن صفاق جداری و احشایی نسبت به روش بستن آن در بهبود پیامدهای کوتاه مدت بعد از عمل از قبیل درد بعد از زایمان و نیاز به آنالرژیک و زمان تخلیه روده کوتاه تر ارجح است.
    کلید واژگان: صفاق، سزارین، عوارض
    Sanam Moradan, Raheb Ghorbani, Marzieh Eslami
    Introduction
    There are many techniques for cesarean sections that each of them has different outcomes. Some clinicians advocate close and some advocate open the visceral and parietal peritoneum. There was different idea about this subject and decided to compare some short term outcomes of two different techniques، closure versus non closure visceral and parietal peritoneum during cesarean section.
    Methods
    This randomized double- blind controlled trial was conducted on 80 term pregnant women who underwent for first elective cesarean section in Amir-Almomenin hospital in semnan، Iran from October 2011 to December 2012. Patients were randomly divided into two groups. In one group parietal and visceral peritoneum were closed (control group) and in second group both layers were left open (study group). All cases underwent cesarean section with spinal anesthesia and the surgery was performed by the same surgeon. The severity of pain was measured over the first 24 hours after operation by visual analogous scale and the dosage of analgesic use، the bowel transit time and wound infection during first week after operation were assessed and compared in both groups. Data were analyzed using SPSS software version 16 and chi-square، Mann-Whitney، Wilkinson، t-test and repeated measures ANOVA tests. P value less than 0. 05 was considered significant.
    Results
    The pain score (p<0. 001)، the mean usage of analgesic over 24 hours (p=0. 012) and bowel transit time (p= 0. 001) in non-closure group was significantly less than closure group. But wound infection was similar in both groups (p= 1).
    Conclusion
    The technique of non-closure of peritoneums has some short term postpartum benefits such as less post operation pain، less amount of analgesic use and more rapid bowel transit time.
    Keywords: Cesarean Section, Outcome, Peritoneum
  • Prevention of Intraabdominal Adhesions by Local and Systemic Administration of Immunosuppressive Drugs
    Kemal Peker*, Abdullah Inal, Ilyas Sayar, Murat Sahin, Huriye Gullu, Duriye Gul Inal, Arda Isik
    Background
    Intraperitoneal adhesion formation is a serious postsurgical issue. Adhesions develop after damage to the peritoneum by surgery, irradiation, infection or trauma.
    Objectives
    Using a rat model, we compared the effectiveness of systemic and intraperitoneally administered common immunosuppressive drugs for prevention of postoperative intraperitoneal adhesions.
    Materials And Methods
    Peritoneal adhesions were induced in 98 female Wistar-Albino rats by cecal abrasion and peritoneal excision. Rats were randomly separated into seven groups, each containing fourteen rats, and the standard experimental model was applied to all of rats. 14 days later, rats were euthanized, intraperitoneal adhesions were scored and tissues were examined histologically using hematoxylin/eosin and Masson’s trichrome staining.
    Results
    Throughout the investigation, no animal died during or after surgery. In all of experimental groups, decrease in fibrosis was statistically significant. Decrease in fibrosis was most prominently in intraperitoneal tacrolimus group (P = 0.000), and decrease was least in intraperitoneal cyclosporine group (P = 0.022). Vascular proliferation was significantly decreased in all experimental groups (P < 0.05) except for systemic tacrolimus group (P = 0.139). Most prominent reduction in vascular proliferation was in intraperitoneal tacrolimus group (P = 0.000)..
    Conclusions
    Administration of immunosuppressive drugs is effective for prevention of intraperitoneal adhesions.
    Keywords: Pharmaceutical Preparations, Immunosuppression, Peritoneum, General Surgery
  • وحید یاردل، نگار سید، نریمان مصفا *
    سابقه و هدف

    تحت گروه لنفوسیتی CD5+ B-1 در مواقع لزوم قادر به تولید آنتی بادی های طبیعی با خاصیت واکنشی متعدد بوده و اصلی ترین لیگاند آنها، لیپوپلی ساکارید (LPS) است. از آنجایی که تولید آنتی بادی ها در شرایط آزمایشگاهی و خارج از بدن موجود زنده می تواند کاربرد بسیاری در تکنولوژی تخلیص مواد داشته باشد، این تحقیق با هدف جداسازی، کشت و تعیین غلظت آنتی بادی در مایع رویی کشت این لنفوسیت ها انجام شد.

    روش بررسی

    این تحقیق با طراحی اکتشافی انجام گردید. با خون گیری مستقیم از قلب، پرفیوژن طحال و خارج سازی سلول های آن و لاواژ پریتونئال موش های نژاد Balb/c سلول ها گرفته شدند و با کمک گرادیان فایکول و ستون نایلون وول، لنفوسیت های B تخلیص گردیدند و در دو گروه مورد و شاهد در محیط کامل کشت سلولی توسط LPS تحریک شدند و در سه زمان 24،48 و 72 ساعت در انکوباسیون قرار گرفتند. مایع رویی کشت به منظور اندازه گیری غلظت IgM با تکنیک الایزا سنجیده و فعالیت حیاتی و قدرت تکثیر توسط آزمون MTT بررسی شد. بررسی های ایمونوفنوتایپینگ برای تایید خلوص سلول ها به کمک مارکر CD3 و CD5 صورت پذیرفت.

    یافته ها

    کشت 24 ساعته لنفوسیت ها در دو ارگان طحال و پریتوئن، بالاترین فعالیت ترشحی IgM را داشتند که اختلاف معنی داری را با گروه های شاهد نشان دادند. در بررسی ایمونوفنوتایپینگ، لنفوسیت های B تخلیص شده از پریتوئن در مقایسه با طحال و خون، درصد بالاتری از مارکر CD5 را نشان دادند.

    نتیجه گیری

    سلول های پریتوئن و طحال منبع بسیار خوبی برای تهیه IgM با اختصاصیت متعدد در شرایط داخل لوله ای آزمایشگاهی می باشند. تخلیص این سلول ها و فراهم نمودن شرایط مناسب کشت سلولی می تواند راهگشای انجام مطالعات جامع تری باشد.

    کلید واژگان: لنفوسیت B، 1، محرک لیپوپلی ساکارید، IgM با اختصاصیت متعدد، طحال، پریتوئن، موش Balb، c
    Vahid Yardel, Nega R. Seyed, Nariman Mosaffa
    Background

    CD5B1 lymphocytes are the major cell subpopulation for defense found in many organs including peritoneum and splenic follicles. They can produce natural antibodies with poly specific reaction with an important Ligand: Lipopolysaccaride (LPS). The aim of this study was isolation and purification of this unique population from cellular content of peritoneum, spleen and blood and determining their functional activity in producing IgM antibody in response to stimulants in cell culture under experimental conditions.

    Methods

    With direct heart puncture, splenic puncture, and peritoneal lavage from inbred Balb/C mice, cells were collected and purified through Ficole density gradient and nylon wool column for purification of B lymphocytes. In complete tissue culture medium (Bwool), cells were harvested and divided into 2 Groups, experimental and control. LPS stimulation was performed on the experimental group for different durations: 24, 48 and 72 hours. Finally culture supernatants were assayed for IgM concentration with ELISA Technique. The proliferation rate was defined by M.T.T assessment. Immunophenotyping studies for confirmation of cellular purity were carried out by CD3 and CD5 markers.

    Result

    Lymphocytes from spleen and peritoneum organs had significantly higher levels of IgM secretory activity in 24 hours, as compared to the control groups. In Immuno-phenotyping studies, purified B lymphocytes from peritoneum showed highest levels of CD5 marker.

    Conclusion

    The findings of this research indicate that Cells collected from splenic puncture and peritoneal fluid are excellent source for IgM antibody with polyspecific properties against LPS in the laboratory and extremely useful for research purposes.

    Keywords: B, 1 Lymphocyte, Lipopoly Saccharide, Poly, specific, IgM, Spleen, Peritoneum
  • سیده هاجر شارمی، زهرا روح بخش
    مقدمه

    عمل‌ سزارین‌ شایعترین‌ عمل‌ جراحی‌ انجام‌ شده‌ در مراکز درمانی‌ بوده‌ و درد پس‌ از عمل‌ ازشکایات‌ شایع‌ بیماران‌ محسوب‌ می‌شود. یکی‌ از مکانیسم‌های‌ درد کشش‌ و ایسکیمی‌ بافت‌ است‌.چون‌ دوختن‌ صفاق‌ ممکن‌ است‌ باعث‌ ایجاد ایسکیمی‌ موضعی‌ و تحریک‌ درد شود.

    هدف

    هدف‌ از این‌مطالعه‌ بررسی‌ تاثیر بازگذاشتن‌ صفاق‌ بر درد پس‌ از عمل‌ سزارین‌ می‌باشد. مواد و روش‌ها: در این‌ مطالعه‌ کارآزمایی‌ دو سوکور‌ نمونه‌گیری‌ بصورت‌ غیرتصادفی‌ (تعداد 150 نفر) وتقسیم‌ بیماران‌ به‌ دو گروه‌ بصورت‌ تصادفی‌ با استفاده‌ از پاکتهای‌ دربسته‌ کددار انجام‌ شد، درگروه‌ مطالعه‌ صفاق‌ جداری‌ بازگذاشته‌‌ و در گروه‌ شاهد صفاق‌ به روش‌ معمول‌ دوخته‌ شد. متغیرهای‌ زمینه‌ای‌ و مورد بررسی‌ در فرم‌ مخصوص‌ جمع‌آوری‌ شد، ارزیابی‌ شدت‌ درد به روش‌مقیاس‌ مدرج‌ دیداری‌ در دو مرحله‌ به‌ فاصله‌ 12 ساعت‌ازهم‌ انجام‌ شد. آنالیز آماری‌ با استفاده‌از آزمون‌ های t ، مان ویتنی و کای دو انجام‌ گرفت‌. 5%= در نظر گرفته‌ شد.

    نتایج

    افراد دو گروه‌ از نظر متغیرهای‌ زمینه‌ای‌، نوع‌ برش‌ شکمی‌ و نوع‌ بیحسی‌ تفاوت‌ معنی‌داری‌نداشتند میانگین‌ شدت‌ درد در گروه‌ مطالعه‌ در هر دو مرحله‌ از گروه‌ کنترل‌ بیشتر بود(001/0

    کلید واژگان: درد، سزارین، صفاق
    S.H. Sharami *, Z. Roohbakhsh
    Introduction

    Cesarean sections delivery is the most common surgical procedures performed in Guilan, and postoperative pain is a common complain in this patients.

    Objectives

    To determine leaving peritoneum opened after Cesarean sections deliveries on postoperative pain in patients.

    Materials and Methods

    In a double blind clinical trial, with a non- randomized sampling 150 patients randomly assigned in two groups: experiment group with leaving peritoneum opened and control group with postoperative closed peritoneum as routine procedures. All information about patients (including background variables and experimental variables) recorded on forms. Pain assessment performed by visual analog scale two times with 12 hours interval. Statistical analysis carried out using t- test, Manwithney test, and chi- squared tests. Type 1 (alpha) error considered 5%.

    Results

    There was no difference on background variables, type of abdominal incisions, and anesthetic methods between two groups. The means of pain numbers had statistically significant differences in two groups (P<0.01) The mean of administering injection analgesics had statistically significant differences (in experiment group less than control group).

    Conclusion

    As leaving peritoneum opened has a lot of advantages such as decrease postoperative adhesion in peritoneum. Based on the findings of this study decreasing postoperative pain is another advantage of that.

    Keywords: Cesarean Section, Pain, Peritoneum
نکته
  • نتایج بر اساس تاریخ انتشار مرتب شده‌اند.
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