Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

Spontaneous perforation of the uterus is rare, its incidence being about 0.01% − 0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain

Recurrent hepatitis in two iranian children: A novel (Q166R) mutation in EIF2AK3 leading to wolcott-rallison syndrome

Early-onset diabetes, liver dysfunction, growth retardation, spondyloepiphyseal dysplasia, and tendency to skeletal fractures due to osteopenia are characteristics of Wolcott-Rallison syndrome (WRS). Eukaryotic translation initiation factor 2α kinase (EIF2AK3) is the only known gene, which is responsible for this rare autosomal recessive disorder. Here, we report two siblings a girl and a boy with diabetes mellitus (DM) who presented in one and two months of age respectively. Recurrent self-limiting hepatitis developed later, and severe hepatic failure resulted in death of the first child. The second child visited was a 7.75 year old boy who had spondyloepiphyseal dysplasia and subclinical hypothyroidism besides DM and recurrent hepatitis. We suggested WRS for this patient, and it was confirmed by identification of a novel homozygous missense mutation (Q166R) in exon 3 of the EIF2AK3 gene. The aim of this report is to remind the possibility of WRS in isolated neonatal diabetes; while, the other clinical manifestations of this syndrome including its major symptom of recurrent hepatitis may appear later. © 2013, Kowsar Corp

Country development and manuscript selection bias: a review of published studies

BACKGROUND: Manuscript selection bias is the selective publication of manuscripts based on study characteristics other than quality indicators. One reason may be a perceived editorial bias against the researches from less-developed world. We aimed to compare the methodological quality and statistical appeal of trials from countries with different development status and to determine their association with the journal impact factors and language of publication. METHODS: Selection criteria: Based on the World Bank income criteria countries were divided into four groups. All records of clinical trials conducted in each income group during 1993 and 2003 were included if they contained abstract and study sample size. Data sources: Cochrane Controlled Trials Register was searched and 50 articles selected from each income group using a systematic random sampling method in years 1993 and 2003 separately. Data extraction: Data were extracted by two reviewers on the language of publication, use of randomization, blinding, intention to treat analysis, study sample size and statistical significance. Disagreement was dealt with by consensus. Journal impact factors were obtained from the institute for scientific information. RESULTS: Four hundred records were explored. Country income had an inverse linear association with the presence of randomization (chi2 for trend = 5.6, p = 0.02) and a direct association with the use of blinding (chi2 for trend = 6.9, p = 0.008); although in low income countries the probability of blinding was increased from 36% in 1993 to 46% in 2003. In 1993 the results of 68% of high income trials and 64.7% of other groups were statistically significant; but in 2003 they were 66% and 82% respectively. Study sample size and income were the only significant predictors of journal impact factor. CONCLUSION: The impact of country development on manuscript selection bias is considerable and may be increasing over time. It seems that one reason may be more stringent implementation of the guidelines for improving the reporting quality of trials on developing world researchers. Another reason may be the presumptions of the researchers from developing world about the editorial bias against their nationality

Simultaneous Bilateral Testicular Metastases from Renal Clear Cell Carcinoma: A Rare Presentation in Von Hippel–Lindau disease

In this article, we present a Von Hippel–Lindau (VHL) patient with synchoronus bilateral testicular metastasis from renal cell carcinoma (RCC). A 50 year-old man, a known case of VHL syndrome was referred with palpable masses in both the testes. His medical history demonstrated that he had undergone the brain surgery for cerebellar hemangioblastoma. He had undergone simultaneous Whipple’s pancreatectomy and left radical nephrectomy becuase of well-differentiated neuroendocrine tumors in head and body of the pancreas and a 6-cm clear cell-type grade-3 RCC in the left kidney. Scrotal sonography demonstrated vascular and heteroechogen masses measuring 19×14 mm in lower pole of the right testicle, 19×16 mm in upper pole of the right testicle, and 23×16.5 mm in upper pole of the left testicle. After having patient’s consent, bilateral orchiectomy was performed by inguinal incision. Histopathologic examination and immunohistochemistry staining revealed metastasis from RCC. The most common neoplasm of reproductive system in VHL patients is epididymal papillary cystadenoma. Owing to it’s benign nature, the management is conservative with routine physical examination and ultrasonography. Our patient indicated that every scrotal mass in patients with VHL is not to be considered as epididymal papillary cystadenoma

Simultaneous selection of high-yielding and drought-tolerant barley landraces using GT, GYT and GYSI methodologies

Locally adapted landraces are the major barley varieties welcomed in the desert climate regions of Iran. These germplasms have potentials in terms of yield and drought tolerance which makes their evaluation worthwhile. To this end, fifty barley landraces along with six check varieties (Nosrat, Yoused, Nimroz, Goharan, Mehr and Khatam) were evaluated under well-watered and drought conditions during 2019–2020 and 2020–2021 growing seasons. The data were analyzed by GT (genotype by trait) biplot and GYT (Genotype by yield*trait) biplot method. Additionally, drought stress tolerant and susceptibility indices, including TOL, SSI, YSI, HM, GMP, MP and STI, were calculated and utilized in the GYT biplot which denominated as GYSI (Genotype by yield*stress index) biplot in this paper. Referring to ATC view and SI ranking of GYT data, 27 genotypes under well-watered and 27 genotypes under drought stress were selected which all were above average with the positive SI values. Likewise, 25 above average drought-tolerant genotypes were identified based on GYSI methodology. Based on the results, plant height and YSI were defined as ideal trait and stress index in combination with grain yield to identify superior genotypes, respectively. Overall, our study determined 12 genotypes which meet all the criteria to achieve high yield and drought tolerance. It could be concluded that combination of GT, GYT and GYSI methodologies led us to simultaneous selection of high-yielding and drought-tolerant genotypes accurately among locally adapted barley landraces of Iran

Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery

Background: Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery. Methods: This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis. Results: The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group. Conclusion: Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system

Xanthogranulomatous cystitis mimicking bladder tumor: A case report

Xanthogranulomatous inflammation, as a type of chronic granulomatous inflammation, typically occurs in the gall bladder and kidneys. In this paper, we present a 56-year-old man with Xanthogranulomatous cystitis mimicking bladder malignancy. He was referred to our clinic with the chief complaint of a one-year history of urgency and frequency. CT scan showed a solid lesion in the bladder. The patient underwent complete transurethral resection of the bladder tumor. Microscopic histopathology revealed xanthogranulomatous cystitis. The patient received a course of antibiotic therapy. Follow-up Cystourethroscopy showed normal bladder

Assessment of health equity consideration in Cochrane systematic reviews and primary studies on urolithiasis

Abstract Background and Aims Health injustice is defined as “unnecessary, preventable, unjustified and unfair health differences.” One of the most important scientific sources on the prevention and management of urolithiasis are Cochrane reviews in this field. Given that the first step in eliminating health injustice is to identify the causes, the aim of the present study was to evaluate equity considerations in Cochrane reviews and the included primary studies on urinary stones. Methods Cochrane reviews on kidney stones and ureteral stones were searched through the Cochrane Library. The included clinical trials in each of the reviews published after 2000 were also collected. Two different researchers reviewed all the included Cochrane reviews and primary studies. The researchers reviewed each PROGRESS criteria independently (P: place of residence, R: race/ethnicity/culture, O: occupation, G: gender, R: religion, E: education, S: socioeconomic status, S: social capital and networks). The geographical location of the included studies was categorized as low‐income, middle‐income and high‐income countries, based on the World Bank income criteria. Each PROGRESS dimension was reported for both the Cochrane reviews and the primary studies. Results In total, 12 Cochrane reviews and 140 primary studies were included in this study. None of the included Cochrane reviews had specifically mentioned the PROGRESS framework in the Method section whereas gender distribution and place of residence were reported in two and one reviews, respectively. In 134 primary studies at least one item of PROGRESS was reported. The most frequent item was gender distribution, followed by place of residence. Conclusion According to the results of this study, the authors of Cochrane systematic reviews on urolithiasis, and researchers who have conducted such trials, have rarely considered health equity dimensions when designing and performing their studies. Therefore, researchers worldwide should be motivated to study populations from low‐income countries with low socioeconomic status in addition to different cultures, ethnicities, and so forth. Furthermore, RCT reporting guidelines such as CONSORT should include health equity dimensions and the editors and reviewers of scientific journals should encourage researchers to further emphasize on health equity in their studies

Spontaneous Endometriosis of the Abdominal Wall

Abdominal wall endometriosis, the commonest type of extra-pelvic endometriosis, may rarely develop spontaneously in the absence of prior surgical scar. We aim to report 3 cases with this unique characteristic, two of them with a diagnosis of unusual development of umbilical endometriosis and one with inguinal endometriosis, from the perspective of a general surgeon. Because of the potential pitfalls in its diagnosis, endometriosis should be emphasized in the differential diagnosis of abdominal wall masses

Torsion of the Wandering Spleen

Wandering spleen, defined as a spleen without its usual peritoneal attachments, is a rare entity. We report a 34-year-old woman with acute abdomen due to torsion of the long vascular pedicle of a wandering spleen, displaced in the abdominal cavity, and infarction of the spleen. Wandering spleen was diagnosed by ultrasound and computed tomography (CT) scan, and was managed by splenectomy in this patient. Wandering spleen usually occurs in 20 to 40 years old women. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. A confirmatory diagnosis of a wandering spleen depends heavily upon imaging studies such as abdominal ultrasound, abdominal and pelvic CT scanning, nuclear scintigraphy or a liver-spleen scan. Treatment options include splenopexy or splenectomy