Abstract Objectives The aim of this study is to review the clinical presentations, diagnostic methods, treatment options and outcome of patients with Granulomatous Mastitis (GM). Material and methods ...In a retrospective study, we indentified 206 women who met the required histological criteria of (GM). Results Thirty eight (18%) of these women had taken antibiotics before their diagnosis of GM. The most common symptoms in remaining 168 symptomatic women were breast mass. The most common ultrasonographic and mammographic finding was large irregular hypo echoic masses and an irregular mass, respectively. As a diagnostic tool, fine needle aspiration (FNA) was performed in 33 (19.5%) and core needle biopsy with or without ultrasound was done in 92 (55%) of patients while successful rate was 13 (39%) and 87 (94.5%), respectively. The remaining 43 (25.5%) of women underwent surgical excisions. Only 6 (3%) patients improved with antibiotics and 200 (97%) of women who did not respond to antibiotics, were treated with steroid and among them 144 (72%) improved. Treatment with combination of methotrexate and steroid was done in 56 (28%) patients and was effective in 40 (71%) of them. Sixteen (8%) patients were treated with a combination of steroid and bromocriptine which was effective in 5 (31%) patients. A wide surgical excision was performed in 11 (5.5%) patients who were nonresponsive to steroid and methotrexate and bromocriptine therapy. Conclusion Our findings indicate that clinical and imaging findings of (GM) have overlapped with malignancy. The best diagnostic method is core needle biopsy. Corticosteroids are in the first line of treatment with a good therapeutic response.
The goal of this systematic review and meta‐analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, ...systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as “Prevalence”, “Surgical wound infection”, “Surgical site infection” and “Orthopedics” from the earliest to the May 1, 2023. The appraisal tool for cross‐sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%–7.2%; I2 = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%–11.7%; p < 0.001; I2 = 99.34%) and 2.6% (95% CI: 1.0%–6.3%; I2 = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1–6.4%; I2 = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%–30.2%; I2 = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%–5.5%; I2 = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%–8.9%; I2 = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%–6.0%; I2 = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%–6.4%; I2 = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co‐morbidity) and fracture‐related factors (surgery site and type of fracture).
Hemodialysis access has been considered as a support for end-stage renal patients. We measured the hemodynamic changes of the distal part of the upper extremity immediately after providing the AVGs ...in each method mentioned above and then compared the results. This method is a novel one and hasn’t been used in any other studies before. We studied 32 patients referred to the vascular surgery department of Rasht Razi Hospital between 2019-2020 (using the Convenient Sampling method). This study is a case-control study. Out of 32 patients referred to the vascular surgery department of the hospital, 68.8% were male, and their mean age was 53.41±12.75 years, ranging from 28 to 78 years. Changes in distal arterial hemodynamics of the upper limb before and after clamping in dialysis venoarterial loop versus straight grafts are different in studied patients (P<0.05). The mean hemodynamic changes before and after clamping in loop venoarterial grafts (19.5000) are less than straight grafts. In dialysis patients who do not have any superficial vein suitable for venous, arterial fistula, surgical placement of artificial grafts in the upper limb is appropriate. Based on the results of this study, the loop method seems to have lesser ischemic Complications and can be applied to dialysis patients.
Background Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is ...intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity. Case presentation A 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst. Conclusion Intrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital. Keywords: Hydatid cyst, Liver, Intrabiliary rupture
Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To ...evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.
Abdominal aortic aneurysm (AAA) is a life-threatening condition. Open surgery and endovascular repair are the options for treating AAA. This study aimed to compare the frequencies of in-hospital ...complications and outcomes in two groups of patients who underwent AAA repair surgery using either an open or an endovascular repair method.
This retrospective study was conducted on the records of 60 patients with AAA undergoing elective surgery repair using endovascular approaches or open surgery at Razi Hospital from 2010 to 2019. Patients' related information, including age, sex, changes in blood pressure, respiratory complications, renal complications, myocardial infarction, paraplegia, cloneischemia, lower limb ischemia, duration of hospital stay in intensive care unit and hospital, the dose of packed RBC, the dose of injectable narcotic analgesics, the need for vasopressor medication, duration of surgery, duration of postoperative oral feeding, and death during hospitalization were assessed.
A total of 60 patients in two groups were studied. The mean age of patients was 72.4 ± 6.28 years, and most were male (86.7%). The incidence of renal complications (3.3%) and respiratory complications (0%), rate of decrease in arterial blood oxygen saturation, length of stay in ICU (median 2 vs. 4) and hospital (median 4.5 vs. 7), the need for vasopressor injection and the dose of packed RBC (median 0.4 vs. 3.33), the dose of narcotic analgesic injection (53.3%), duration of surgery (median 2.5 vs. 3), duration of postoperative oral feeding (median 23 vs. 54), and the incidence of death were significantly lower in the endoscopic surgery group.
Endovascular surgery repairing the rupture of an AAA is associated with fewer postoperative complications and in-hospital death than open surgery.
Breast cancer is one of the most common types of cancer in women, affecting many women worldwide every year. Breast cancer screening is one of the best strategies to reduce the death rate caused by ...this cancer. The aim of this study was to evaluate the prevalence, epidemiology and screening results of breast cancer in women in Guilan province.
This cross-sectional study was carried out on 300 women who participated in the screening program in Guilan province during 2017–2018. The data were collected by a breast screening questionnaire. Finally, the data were analyzed using chi-square and independent t-tests.
The mean age of the patients was 49.96 ± 6.53 years old and the estimated prevalence of breast cancer was 1.7% (95% Confidence interval (CI): 0.6–3.6). Physicians examination were significantly associated with breast cancer status (P = 0.003). The results also showed that the percentage of malignancy and benignity in the center (69 patient, 52.3%), west and northwest of Guilan (69 patient, 54.8%) was more than descriptive in East Guilan (20 patient, 47.6%). But it was not statistically significant (P = 0.730). The accuracy of mammography results (BIRADS) and sonography were 69.76% and the kappa coefficient was 0.44 (p < 0.001).
Implementation of screening programs in women should be considered and breast screening using mammography is one of the valuable methods for early detection of breast lesions, which is associated with a better prognosis of cancer.
Abstract
Primary simultaneous multiple organs teratomas are extremely rare. They usually arise in the gonads, and only 1–3 % of them arise in the mediastinum. We present a case of simultaneous ...multiple organs immature teratomas who was admitted to Razi hospital because of cough, dyspnea, and left-side supraclavicular mass. Computed tomography (CT) showed a big mass with multiple high densities, nodular, semi-solid, heterogenic structures on the left side of the neck, left-side anterior mediastinum, right-side middle mediastinum and right-side suprarenal region. CT-guided needle biopsy was performed and histopathological study showed immature teratoma. After performing neoadjuvant therapy, the tumors were removed. The patient underwent chemo radiation therapy on the mediastinum and abdomen. On 6-months follow-up, he was asymptomatic. This case is being reported because of the rarity of multiple organs immature teratomas and informing other clinicians about managing these cases.
Hospital‐acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound ...infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross‐sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro–Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre‐ and postoperative antibiotic use. Gram‐positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase‐negative staphylococci. In addition, the most common Gram‐negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection‐associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.
Boerhaave's syndrome (BS) is a rare spontaneous perforation of the esophagus with a high rate of morbidity that results in death in the case of delayed diagnosis and treatment. Here, we describe a ...patient with achalasia who was diagnosed with BS.
This present case is a 63-year-old man with a previous history of achalasia and with a complaint of sudden onset of severe right chest pain, epigastric pain, etc. to Razi hospital, Rasht, Iran in March 2022.
Due to the clinical findings of the patients, the diagnosis was BS and the patient's condition was reported to be good at the two-month follow-up.
Early diagnosis of BS results in more effective treatment. Also, stenting is suggested to be effective to reduce the rate of morbidity and mortality in patients with BS.
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