Giant Solitary Fibrous Tumor of the Liver, Case Report: Unusual Site, Extravagant Presentation, Aggressive Behavior

Background: Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal tumor. It can originate from abdominal soft tissue which is extremely scarce, and liver indeed is super scant site. SFT liver (SFTL) is mostly benign, but it can be malignant and aggressive with metastases and a potential of recurrence. Hypoglycemia is the least reported feature which is resistant to medical management and will be resolved following resection of a SFT of liver.Case Report: A 67-year-old man presented with episodes of sudden onset loss of consciousness since 3 months before first visit. He was a previously healthy farmer, without any other complaint or past medical history except for episodes of sever hypoglycemia. Laboratory testing revealed hypoglycemia which was temporarily response to glucose infusion, hypoglycemia was refractive, and whole physical examination and laboratory tests were done and there were no abnormal findings. With probability of finding something such as insulinoma or any other tumor that secreted insulin or insulin-like growth factors, a magnetic resonance imaging (MRI) was performed and revealed an enhancing giant round and well-defined lesion in left lobe of live.Conclusions: We here present the first case of malignant SFTL presenting with hypoglycemia and metastasis to soft tissue as inguinal bulging 2 months after resection of liver mass, but this particular type of tumor needs more evaluation and investigation

Prognostic Value of Serum Fibrinogen Level in Determining the Severity of Appendicitis Inflammation in Adult and Pediatric Patients Undergoing Appendectomy in Two Local Centres in Tehran

Background: Despite the recent advancements, negative appendectomy cases are notable, especially in children. We evaluated the prognostic value of serum fibrinogen level for the prediction of the severity of acute appendicitis. Methods: A cross-sectional study of children and adults who had undergone appendectomy at Ali Asghar and Rasool-e Akram hospitals, Iran, was performed. Before surgery, serum fibrinogen level was assessed by using the Clauss technique. Finally, serum fibrinogen was compared between the two groups of complicated acute appendicitis and uncomplicated ones. Results: In the adult's complicated and uncomplicated appendicitis, no significant differences were noted in gender distribution, WBC count, and segment levels. Serum fibrinogen and C-reactive protein levels in children with complicated appendicitis were significantly higher than those in the uncomplicated ones. Serum fibrinogen level of 450 mg/dl was the optimum cut-off for predicting the severity of appendicitis in children. Serum fibrinogen level in adults with the complicated appendicitis was significantly higher than the uncomplicated appendicitis group. Also, 530 mg/dl was found the best serum fibrinogen cut-off to predict the severity of appendicitis in adults. Conclusion: Serum fibrinogen level is an appropriate diagnostic marker for the distinction of acute complicated appendicitis from uncomplicated appendicitis in children and adults

A primary subclavian artery aneurysm successfully repaired via extrathoracic open approach: a case report

Subclavian artery aneurysms are uncommon; meanwhile, isolated subclavian artery aneurysms are extremely rare entities. There are limited number of reports on this abnormality, most of which are not well grounded.The patients presenting with subclavian artery aneurysms should be evaluated thoroughly for concurrent aneurysms. Herein, we presented a case of true aneurysm of the right subclavian artery with no associated abnormalities of other parts of vascular system or any predisposing factors, previously reported in cases with this condition

Pleural involvement and dyspnea as primary presentations of an occult gastric cancer: a case report

Herein, we reported a case of malignant pleural effusion as the initial metastatic presentation of occult gastric cancer in a 52-year-old diabetic woman. This is the first report of gastric cancer metastasized to pleura as a primary presentation. The pathologic results of adenocarcinoma pleural specimens were indicative of an undifferentiated cancer. Based on the results of immunohistochemistry, we suggested the metastasis of gastric cancer. For patients with such distinct clinical presentations, it would be suitable to study gastric cancer as one of the probable primary sites

Interconnection of severe obesity, gastric intestinal metaplasia, gastric cancer, bariatric surgery and the necessity of preoperative endoscopy

Obesity is a growing challenge around the globe accounting for approximately 1.7 billion adults with reduced life expectancy of 5–20 years and these patients are at greater risk for various cancers. Bariatric surgery is one efficient an approved treatment of severe obesity for losing weight and to decrease associated health complications. Besides correct indications and contraindications as well as the various risks of individual bariatric surgical procedures, many more variables influence decision-makings, such as patient’s family history of diseases, as well as individual patient-specific factors, patient and family socioeconomic and nutrition status, and professionalism of a bariatric surgical unit and the presence of intestinal metaplasia that is the replacement of columnar epithelial cells by intestinal architecture and morphology. Patients with severe obesity undergoing esophagogastroduodenoscopy (EGD) and biopsy prior to bariatric surgery may present with gastric IM because regular follow-up to early diagnosis of any subsequent pathological changes is necessary and reveals the importance of addressing interconnections between pre-existing conditions and outcomes. However, there is currently no unified recommendation about preoperative EGD before bariatric surgery. With this short review, we point out the necessary knowledge that undermines why the responsibility for a patient with severe obesity cannot be divided across various disciplines, and why we recommend that EGD always be performed preoperatively

Comparison of the one-year recurrence rate of direct inguinal hernia repaired with lichtenstein procedure under general versus spinal anesthesia

Background and aims: Inguinal hernia are a condition that needs to be repaired through surgery in most of the cases. The recurrence of this condition is a problematic issue that highlights the importance of the identification of the factors preventing form the incidence of this condition. Regarding this, the present study was conducted to determine and compare the one-year recurrence rate of direct inguinal hernia operated with Lichtenstein method under general versus spinal anesthesia in Rasoul Akram Hospital, Tehran, Iran, during 2015-2016. Materials and Methods: This observational cohort study was conducted on 80 consecutive patients with direct inguinal hernia operated with Lichtenstein method in Rasoul Akram Hospital in 2015-2016. The patients undergoing inguinal hernia surgery under general and spinal anesthesia were compared in terms of the one-year recurrence rate of this medical condition.Results: According to the results, the recurrence rate of 5% was obtained for each of the two groups. There was no significant difference between the two groups regarding the recurrence rate (P>0.05). In addition, no related factor for inguinal hernia recurrence was observed in the study groups (P>0.05). Conclusion: Based on the findings, it can be concluded that the type of anesthesia (i.e., general versus spinal method) exerted no significant effect on the recurrence rate of direct inguinal hernia

Patency and outcomes of tunneled hemodialysis catheter via femoral versus jugular vein access

The design of a suitable catheter to achieve a permanent, economical, and efficient vascular pathway for hemodialysis has been always accompanied by difficult and potential complications. Various strategies have been adopted to minimize the use of tunneled catheters that are used for dialysis. Regarding this, the present study aimed to assess the success, patency, as well as early and late complications of cuffed femoral and jugular hemodialysis catheters. This case–control study was performed on 145 hemodialysis patients who were candidates for the insertion of tunneled hemodialysis catheters at Rasoul-e-Akram Hospital in Tehran, Iran, during 2015–2016. The data were collected retrospectively by reviewing the patients' medical records. The participants were divided into two groups of femoral and jugular accesses, based on the type of catheter they had. To determine the procedure-related outcomes, they were assessed 1 week, 1 month, and 6 months after catheterization. According to the results, the mean times of catheter efficacy (patency) were 4.43 ± 3.11 and 5.65 ± 4.57 months in the femoral and jugular access groups, respectively, showing no significant difference between the two groups (P = 0.095). Furthermore, the femoral and jugular access groups had the infection prevalence of 23.2% and 16.2%, thrombosis prevalence of 28.6% and 20.9%, and mortality rates of 3.5% and 1.4%, respectively. According to the multivariable linear regression model, the history of catheterization could predict reduced catheter patency. In addition, catheter-related infection could be predicted among females based on the multivariate logistic regression analysis. As the findings indicated, femoral and jugular hemodialysis catheter insertions showed no significant difference in terms of the mean patency, complications (e.g., infection and thrombosis), and mortality rate