Resolution of Posterior Nutcracker Syndrome through Left Renal Vein Ligation: A Case Report

This case report presents the clinical course of a 54-year-old male patient diagnosed with posterior Nutcracker Syndrome (NCS). The patient experienced recurrent episodes of macroscopic hematuria and severe left flank pain. He was diagnosed with retro-aortic left renal vein (RLRV), an unusual congenital abnormality, which can result in the compression of the left renal vein between the aorta and the vertebra. Initial attempts at conservative management and endovascular interventions were unsuccessful. An open surgical intervention was ultimately performed. The surgery involved ligation of the left renal vein. Postoperatively, the patient experienced marked improvement in symptoms, with complete resolution of hematuria and pain. Furthermore, renal function remained stable, and no kidney-related complications were reported. This case suggests that, in certain situations where endovascular intervention and transposition of LRV or re-implantation of the left gonadal vein are not feasible, ligation of the LRV may provide a safe and practical treatment option for patients with posterior NCS. Future research is needed to validate these findings

Treatment of Great Saphenous Vein Insufficiency by Endovenous Laser Therapy: Clinical Description and Short Term Follow up of 20 Iranian Patients

INTRODUCTION: Endovenous Laser Therapy (EVLT) for Greater Saphenous vein (GSV) insufficiency is a newly established method of treatment only recently made availablein Iran. The present study seeks to describe the results of the first 20 patients treated with EVLT at Shohada-e Tajrish Medical Center, Tehran, Iran.METHODS: 20 patients (16 male, 4 female) with the mean age of 38.9 and an average length of symptoms of 5.9 years, were treated with a 980-nm laser diode under local anesthesia. CEAP classification (Clinical Severity, Etiology, Anatomy, Pathophysiology) and AVSS scores (Aberdeen Varicose Vein Symptom Severity Score) were used to determine disease severity and symptoms before and after the procedure. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation.RESULTS: The mean procedure time was 49 minutes, and the mean admission time was 1.1 days. A success rate of 85% percent was recorded at 6-12 months of follow up. The patients showed a significant reduction in AVSS and CEAP scores (PV=0.0001), Pain (PV=0.00001), Parasthesia and Edema (PV=0.001).CONCLUSION: EVLT seems promising as a novel method of treatment for GSV insufficiency in the Iranian population with many advantages, including higher success rates in comparison with conventional methods of treatment

Iliac vein stenting in a patient with lower extremity swelling resulting from diffuse pelvic mass: A case report

We report a 66-year-old male patient with severe right lower extremity swelling resulting from diffuse pelvic mass with compression on right external iliac vein. The patient had papillary urothelial carcinoma of bladder seven years ago and radical cystectomy and ureterostomy was performed. Recurrence of malignancy had occurred five years after the operation. The patient had also bilateral diffuse lung metastasis. The external iliac vein had severe stenosis and invasion of pelvic mass into the vein was evident on venography. Venoplasty of external iliac vein was performed throughout the stenosis. A venous stent of 80 mm length and 12 mm diameter was introduced over the guidewire and deployed in the external iliac vein. Dramatic clinical response was evident since postoperative day two. Swelling of right lower extremity was resolved dramatically on three-month and six-month follow-up visits. We believe that endovascular venous recanalization of iliac veins is feasible and safe in patients with unresectable and diffuse pelvic masses

Analyzing the Impact of COVID-19 Pandemic on Different Educational Aspects of Surgical Specialties’ Residency Program: A Preliminary Report

Introduction: The lifestyle and learning of trainees from different surgical specialties have been severely affected by the COVID-19 pandemic. Despite the growing body of research, the extent to which their surgical or educational performance is affected is not yet well-understood. We investigated the Iranian multi-specialty surgical residents nationwide to clarify the extent this new pandemic’s has affected their surgical and educational activities. Material and Methods: Our specialized board designed a questionnaire which was sent to residents from the 18th of May to 12th of Jun 2020. The questionnaire comprised demographic data, questions on the clinical, surgical, and educational activities during and before the pandemic. Results: Out of 700 eligible residents, 543 (77%) submitted their answers to all questions. 417 (76.8%) of the respondents declared they had spent their residency program at a hospital that was the main referral center for patients with COVID-19 infection. The weekly number of the outpatient and emergent visits decreased by one third (P<0.001) and one-half (P<0.001), respectively, following the pandemic. Also, the amount of surgeries has dramatically decreased (P<0.001). The median weekly hours devoted to face-to-face activities decreased, while the study time increased and the share of virtual education has a five-fold increase (P<0.001). Conclusion: This pandemic had a significant impact on many aspects of training in surgical specialties’ residency program in Iran. Increasing the time available to study is an opportunity, and online education, despite its challenges, has been effective

Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran

INTRODUCTION: Patient registries play an important role in obtaining real-world evidence of the cost-effectiveness of treatments. However, their implementation is costly and sometimes infeasible in many middle-income countries (MICs). We explored the combination of data-mining and a large claims database to estimate the direct healthcare costs of HER2-positive breast cancer (BC) treatment in Iran and the fraction of total costs from trastuzumab use.METHOD: We performed a retrospective analysis of claims data from the Iran Social Security Organization, a health insurer which covers approximately 50%(~40 million) of the Iranian population, in the period of 21/03/2011-20/03/2014. A data-mining algorithm using R software and validated using patient dossiers in the Cancer Research Center identified 1295 patients and divided them into the three main HER2-positive breast cancer stages (early, loco-regional and advanced). A payer perspective was used to calculate the absolute and relative direc

Examining the effect of antibiotic administration timing on infection rates following hernia surgery

Background and Objective: Hernia is the weakening or disruption of the fibrous-muscle tissue of the body wall through, which intra-abdominal structures pass. The lack of consensus about the antibiotic prescription and the appropriate time led to some non-appropriate antibiotic use. Recognition of the best time can help to better preventive approaches in the patients. Materials and Methods: In this study, 110 male patients who were electively referred for inguinal hernia repair were enrolled and divided into two sections of 55 patients, with one group receiving preoperative antibiotics and the other receiving postoperative antibiotics. The infection rates were compared between the groups. Results: The results of this study showed that age, BMI, duration of operation, and hospital stay were alike across the groups (P > 0.05). There was no infection in any of the classes. Conclusion: Overall, the findings of this study indicate that the rate of infection in cases of mesh reconstruction of inguinal hernia is minimal, and the rate is the same in those with a preoperative and postoperative antibiotic prescription. This suggests the guidelines should be changed in order to shorten the duration and dosage of antibiotic treatment as well as the length of stay for these patients in hospitals. &nbsp

Unveiling a pseudoaneurysm at the anastomosis site in a transplanted kidney: An initial misclassification as hydro nephrosis - A case report and literature review

A 31-year-old woman who developed large Psudoaneurysm after kidney transplantation is discussed. The patient was presented with an 11 cm mass, which became larger gradually. Minimally invasive endovascular stent graft placement was successfully done