Giant megacolon caused by anterior displacement of the anus in a 71-year-old woman

The patient was a 71-year-old woman who was referred to the general surgery clinic due to a severe colonic dilatation and a fecal mass that was found in her abdominopelvic CT scan, which was ordered by a nephrologist for approaching her right flank pain. The patient had experienced bloating and progressive abdominal distension in the year prior to the current visit. The last defecation had occurred approximately 20 days prior to the visit, and the last gas passage had occurred the day before the visit.&nbsp

Using 360-degree multi-source feedback to evaluate professionalism in surgery departments: an Iranian perspective

Background: Medical professionalism helps physicians adopt a proper and good healing action for the patients based on their particular circumstance. This study was conducted to assess professionalism in surgical residents, using a 360-degree evaluation technique in several teaching hospitals in Tehran, Iran. Methods: This study was conducted on all the second and third year surgery residents from three university teaching hospitals in Tehran. Multi-source feedback questionnaire contained 10 questions on the residents’ professional behavior and was completed by the faculty and staff members (nurses, operation room staff, and medical assistants) as well as other surgery residents, interns and patients to evaluate each resident. Response rates were used to determine feasibility for each of the respondent groups and the mean and standard deviation score for each question was computed to determine the viability of the items. Reliability was assessed using alpha Cronbach coefficient for each respondent group. The correlation between these scores and the residents’ final and OSCE grade was also assessed. Results: The internal consistency reliability for 360-degree rating was 0.889. There was no significant difference in the residents’ score in different hospitals. While male residents obtained higher total score, there was no significant difference between them. The residents, however, obtained lower scores compared to the staff. The highest score was recorded for question 6, suggesting that the residents treated the patients regardless of their socioeconomic status. Conclusion: This study revealed a strong agreement between the results gathered from different respondents, confirming the reliability of the questionnaire and the respondents’ unbiased response. It also revealed that the residents did well in the whole test, showing they were conscientious and learning to become medical professionals

Approach to Acute Abdominal Pain: Practical Algorithms

Context: Acute abdominal pain is one of the most common complaints of patients admitted to emergency units. This study aimed to propose a new approach to abdominal pain by designing a more structured diagnostic workup for physicians. Evidence acquisition: A comprehensive review of relevant articles and algorithms presented in books and websites was conducted. Approaches which were relevant to the study concept, were selected. Results: Seven algorithms were introduced with respect to the site of abdominal tenderness. The mainstay of these algorithms was differential diagnosis of the tenderness site. Conclusion: Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems

Patency rate and factors affecting the clinical outcome of patients with aortoiliac artery occlusion undergoing intra-arterial stenting

Background Occluding plaques are commonly found inthe infrarenal aorta and the iliac artery in patients with peripheralarterial disease (PAD). Aortoiliacocclusive disease(AIOD) occurs commonly in patients with PAD.Methods: This is a prospective study was carried out between2015 and 2017 in Sina hospital. Patients with occlusionin aortoiliac artery and its branches were included.Stent was placed for patients, if they had any obstructionor stenosis in aortoiliac artery in angiography. Patientswere examined in terms of clinical status and ABI calculationand underwent Color Doppler ultrasound of aortoiliacartery to determine patency rate at 1, 3, 12, and 24months after stent placement.Results: The mean age of patients was 64.60 (±10.41).The main symptoms of the patients were claudication(41.8%), ulcer (27.3%), pain at rest (20%), and gangrene(20%). The lesion was bilateral in 21 patients (38.2%).According to TASC stratification, lesions were of type A in26 patients (47.3%), type B in 4 patients (7.3%), type Cin 5 patients (9.1%), and type D in 20 patients (36.4%).The six-month, one-year, and two-year patency rates were89.1%, 83.6%, and 72.7%, respectively. The mean annualABI of patients was 0.79 (±0.11) and two year ABIwas 0.68 (±0.1).Conclusion: It seems that stenting and angioplasty areeffective in improving patients’ conditions and result in agood short and medium-term patency

A large gastrointestinal stromal tumor of duodenum: a case report

Background: Gastrointestinal stromal tumors are gastrointestinal tract mesenchymal tumors with gene mutations. The most common site of gastrointestinal stromal tumors is in stomach (40-60%) and small intestine (30-40%), and rare cases about 3-5% of them occur in the duodenum. Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitoti

A diagnostic challenge; pelvic solitary fibrous tumor (SFT) mimicking Peri‐Anal gastrointestinal stromal tumor (GIST): A case report

Key Clinical Message The study reports a rare case of pelvic solitary fibrous tumor (SFT) that was initially considered as a peri‐anal gastrointestinal stromal tumor due to similar radiologic/pathologic features. SFT diagnosis can be challenging due to its rarity and wide range of diagnoses that must be ruled out precisely. Abstract Solitary fibrous tumors (SFTs) are rare tumors that can occur in any part of the body. Although usually benign, malignant SFTs have been reported, especially outside the lungs. Radiology can help with diagnosis, but immunohistochemistry is necessary to distinguish SFTs from other possible diagnoses such as gastrointestinal stromal tumors (GISTs). This study presents a rare case of pelvic SFT initially considered to be a peri‐anal GIST, highlighting the importance of accurate diagnosis given the rarity of SFTs and the need to rule out other potential diagnoses

Laparoscopic cholecystectomy during pregnancy : a case series

Impact Factor for 2020 is 1.407 Click here to view optimized website for mobile devices Journal is indexed with PubMed and Science Citation Index Expanded ORIGINAL ARTICLE Year : 2008 | Volume : 4 | Issue : 1 | Page : 9-14 Laparoscopic cholecystectomy during pregnancy: A case series Hadi Ahmadi Amoli, Hassan Tavakoli, Ali Yaghoubi Notash, Maryam Sajad Far, Patricia Khashayar Department of Surgery, Tehran University of Medical Science, Tehran, Iran Correspondence Address: Hassan Tavakoli Amir Alam Hospital, Tehran Iran Login to access the Email id Source of Support: None, Conflict of Interest: None Crossref citations Check PMC citations 1 DOI: 10.4103/0972-9941.40991 Rights and Permissions ¤ Abstract This study was conducted to evaluate the safety of laparoscopic cholecystectomy (LC) during pregnancy. Patients who underwent LC were selected from several hospital databases, only six were performed during pregnancy. In this series, one of the two patients who had LC in the first trimester underwent elective termination of pregnancy while the other one gave birth to a term child normally. Half of the four who had the second trimester LC had normal deliveries at term whereas for the other two cesarean section was performed. None of our patients underwent LC in the third trimester. The findings of the present study suggest LC to be a safe procedure performed during the first and second trimester of pregnancy

Laparoscopic cholecystectomy during pregnancy: A case series

This study was conducted to evaluate the safety of laparoscopic cholecystectomy (LC) during pregnancy. Patients who underwent LC were selected from several hospital databases, only six were performed during pregnancy. In this series, one of the two patients who had LC in the first trimester underwent elective termination of pregnancy while the other one gave birth to a term child normally. Half of the four who had the second trimester LC had normal deliveries at term whereas for the other two cesarean section was performed. None of our patients underwent LC in the third trimester. The findings of the present study suggest LC to be a safe procedure performed during the first and second trimester of pregnancy

Firework-related injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori)

Background: Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). Objectives: This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. Methods: This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. Results: There were 197 patients enrolled in the study with a mean age of 20.94 +/- 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. Conclusion: The fireworks used during a Chaharshanbeh Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities. (C) 2011 Elsevier Inc

Trauma-Related Morbidity and Mortality in Elderly Patients

Objectives: The purpose of this multi-center study was to investigate the probable predictive factors of mortality and morbidity in elderlypopulation. Methods & Materials: The descriptive prospective study was conducted based on the data gathered from trauma cases older than 65 years admitted to Sina, Shohada and Fayaz-Bakhsh trauma centers during years 1997-98. A pre-prepared questionnaire including the demographic data of the cases and information on the mechanism and the severity of the injury was filled for all the patients upon their arrival in the emergency department it was, thereafter, completed in terms of the therapeutic measures and procedures performed for the patients and the outcomes (discharge, death, …) following their admission. Thegathered data were then analyzed. Results: A total of 296 patients with the mean age of 71.8 met inclusion criteria. Motor vehicle accident was the most frequent mechanism of injury. Overall 18 patients (6.1%) died, which mostlyhappened in the ICU. Conclusion: The type and severity of the injury assessment based on ISS and GCS scores were the most important factors to predict mortality. The statistics showed that there was not a significant correlation between general surgery and the rate of mortality, whilethe orthopedic operation had a significant role in decreasing mortality