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Background: Inguinal hernia repair is the most frequent operation in general surgery. The chance of a person having to undergo an inguinal hernia operation during his/her life is quite high, 27 % in men and 3 % in women. European Hernia Society guidelines state that the Lichtenstein technique (mesh-based repair) is the standard treatment of elective inguinal hernia in adults. Some authors consider the Shouldice technique (tissue-based repair) the best conventional method for open hernia repair. In this study, we compared these two methods. Methods: In This randomized study, 452 patients were randomly allocated into 2 groups. 51 patients were lost during follow-up period and were excluded from further analysis in the study. Finally, the analyzed patients were 183 patients in Shouldice technique group and 218 patients in Lichtenstein technique group. All patients were examined after 1 week, 1, 3 months, 1, 2, and 3 years after the operation date. Results: After 3 years follow up Recurrence of hernia in Shouldice technique group was 7.1 % and in Lichtenstein technique group was 3 % with significant differences (p-value 0.006). No statistically significant differences were found between the groups in wound infection, Seroma, hematoma, Hydrocele, Bladder damage, chronic pain in the inguinal region, and Patient Satisfaction level after surgery. Conclusion: It seems that inguinal hernia treatment by the Lichtenstein technique is better than the Shouldice technique in elective patients.

Abstract Sigmoid volvulus accounts for 20%–50% of colonic obstructions in Eastern countries. This occurs mostly in patients with a lack of mobility and a history of chronic constipation. There are some very known complications of a undescended intra‐abdominal testicle such as cancer, ischemia, and infertility; But the rotation of the colon around the spermatic cord of one UDT is a very rare phenomenon that there is no similar report. A 67‐year‐old man came to the emergency department with a complaint of abdominal pain and obstipation. On examination, patient was febrile (T: 38.5) and had mild general tenderness. According to the appearance of coffee beans in the X‐ray, the diagnosis of sigmoid volvulus was made. In the requested tests, leukocytosis was observed. Rectosigmoidoscopy was unsuccessful. The patient underwent laparotomy. After manual untwisting, a tubular structure at the base of the meso‐sigmoid was noticed. With further exploration, the testis was observed intra‐abdominally. Orchidectomy and sigmoidectomy were performed by Hartmann's method. Sigmoid volvulus is one of the common cases that surgeons frequently encounter. The case scenarios are often the same, and from experience, most cases result from a long meso and an elongated sigmoid secondary to prolonged constipation. Therefore, it is clear that a scrotal examination would not be part of the routine examination of a patient with sigmoid volvulus. In this article, by reporting a very rare etiology for a very common pathology, we tried to point out the importance of head‐to‐toe examination in all patients.

Background: Neurilemmomas also called schwannomas are benign tumors originating from the Schwann cells participating in the peripheral nerve sheath and the pathophysiology of the formation of these tumors is not completely understood. Schwannomas are mostly benign with equal incidence rate in men and women. These tumors have been mainly found in the head and neck, upper extremities, and the trunk. Lower extremity schwannomas are extremely rare, specifically in the dorsum of the foot. Case Report: In this report, we present an 18-year-old man referred to surgery clinic with a painful mass on the anterolateral dorsal aspect of his left ankle with radicular pain and paresthesia to the distal dorsum of the forefoot. After completing all the assessments including ultrasonography and magnetic resonance imaging (MRI), he underwent the surgical resection procedure. The pathology laboratory reported an encapsulated 35 * 20 * 15 mm solitary benign schwannoma. Conclusion: The dorsal aspect of the foot is an extremely rare site for schwannoma formation, but practitioners should always be aware of rare underlying diseases for neurologic deficits or just a simple pain in the lower extremities.

Background: In case of a stab wound to the lower cervical region and upper dorsal region, many organs are prone to damage, including the lung, heart, pericardium, any of the vessels in the thoracic cage, the esophagus or trachea, thoracic duct, and even spinal cord. Case Report: A 19 year-old patient arrived at the emergency department with swollen and painful upper dorsal region between the internal border of the left scapula and T2 vertebra. The patient had a history of a street fight with a stab wound on the corresponding area. Nothing abnormal was found on physical examination, and the patient was stable without any neuroglial deficit. Radiographic imaging demonstrated a foreign body lodged near the vertebra. The patient underwent an operation surgery, and the foreign body was removed without any serious complications. The foreign body was the blade of the stab, which was broken and hidden under soft tissue. Conclusion: According to guidelines for a stab wound to the thoracic, a chest x-ray and exploration of the area must be performed, which were missed in the present case and potentially could lead to serious complications given multiple vital organs in that anatomical region.

Abstract Background and Aims Ventilator‐associated pneumonia is highly prevalent nosocomial infection among patients under mechanical ventilation. Bronchoalveolar lavage (BAL) is effective in identifying the type of pathogen involved and determine the course of antibiotic. The aim of this study was to evaluate the prevalence of different pathogens involved in ventilator‐associated pneumonia (VAP) and associated antibiotic resistance and sensitivity pattern. Methods In this descriptive cross‐sectional study, patients admitted to the intensive care unit under mechanical ventilation at Shahid Madani Educational and Medical Center in Karaj during 2018 and 2020 were included. BAL samples were obtained from the patients. Demographic data, duration of hospitalization, duration of mechanical ventilation, and antibiotic susceptibility and resistance tests were recorded for all the patients. Results Among 335 patients included in the study, 215 (64.2%) were males. The mean age of the patients was 55.06 ± 14.90 years. The most common pathogens reported were Acinetobacter baumannii (40%), Pseudomonas aeruginosa (21.2%), and Staphylococcus aureus (13.4%). The mean age of the patients, gender, duration of mechanical ventilation, and duration of hospitalization were not associated with the type of pathogen, P > .05, respectively. Conclusion BAL of these patients indicated that various pathogens are responsible for VAP, and can vary from patient to patient. Antibiotic resistance and susceptibility pattern of these pathogens vary and therefore is important in determining the course of the treatment.

Recent studies have suggested that morbidity and mortality rate of transhiatal esophagectomy is comparable to that of thoracotomy, calling the need for the modifications in the surgical procedures. Our methodology includes stripping of esophagus by nasogastric tube to reduce the manipulation of thoracic cavity and associated complications. We also present the comparison between the stripping and classic (Orringer's technique) esophagectomy. Patients presenting esophageal carcinoma from 2015 to 2017 were the target of this study. Patients undergoing esophagectomy were randomized to have classic or stripping esophagectomy. Operating time, manipulation time, blood losses during the surgery, duration of hospitalization, volume intake, hypotension time, arrhythmia, and transfusion were the recorded parameters. Complications, such as anastomotic leak, cardiac effects, and morbidity, were also studied. Seventy patients were referred for transhiatal esophagectomy for esophageal carcinoma at the Al Zahra Hospital. Mean ages of patients in the stripping and Orringer group were 64.00 ± 10.57 and 57.42 ± 12.20 years, respectively. Manipulation time, operating time, blood loss during the surgery, and transfusion were statistically significant variables between the two groups. Although volume intake and duration of hospitalization were not significantly different parameters, however, betterment in the outcomes was evident. Substantial decrease in overall complications via stripping method was obtained, hence can be suggested as an effective alternative, to remove the need of thoracotomy, for transhiatal esophagectomy.

Abstract A woman with a clinical presentations of granulomatosis with polyangiitis (GPA) has been presented. Tension pneumothorax has been rarely reported; however, it is a life‐threatening condition. Surgical intervention may be required in GPA patients who do not respond to chest tube insertion. Timely management can reduce the complication and mortality.

Abstract A case of peritonitis following the repair of perforated peptic ulcer using omental flap. The revision surgery was performed using pedicled falciform ligament flap, and no postoperative and one‐month follow‐up complications were reported. In cases of perforated peptic ulcer that cannot be treated with omentopexy, use of a falciform ligament.

Introduction: Opiate (including heroin) use prevalence is 1.2% of the world population according to the last report of UNOCD. In Iran about 2 million people of population are drug abusers..Heroin reduces gastric motility and prolongs gastric emptying time and it can cause gastric dilation which can be a reason for gastric ischemia . Gastric ischemia is an uncommon condition do to the rich gastric blood perfusion and collateral arteries . As some of studies show, gastric dilation can be a cause for gastric necrosis. Case presentation: A 22-year-old woman who presented to our hospital with severe abdominal pain and several episodes of vomiting. The patient declared that she had a history of addiction to methamphetamine and heroin. In abdominal examination, a soft and non-distended abdomen with generalized tenderness, mostly in hypogastric region without rebound tenderness was revealed.Abdominal radiograph revealed a much distended stomach. A non-contrast CT abdomen confirmed severe gastric dilatation. On endoscopy, multiple necrotic lesions were seen throughout the stomach and mostly in the proximal part. Our finding in the laparotomy was gastric necrosis in the proximal part, which resulted in a total gastrectomy. esophagojejunostomy with roux en y reconstruction was done after total gastrectomy. Conclusion: Opioids can increase the risk of GI dysfunction and they can increase risk of infection in GI tract. In our case ,abuse of heroin caused a gastric dilation and massive gastric necrosis.

Abstract Background and aims Acute appendicitis is one of the common causes of abdominal surgeries, however, the rate of negative appendectomy is as high as 20% as the diagnosis of appendicitis is challenging. The study aimed to evaluate complete blood count (CBC)‐associated parameters among positive and negative appendectomy patients and determine their diagnostic importance. Methods In this cross‐sectional study, patients who suspected of acute appendicitis were included. Preoperative blood samples taken from these patients for a complete blood count. Following parameters evaluated from their CBC: white blood cell (WBC), platelet (PLT), mean platelet volume (MPV), neutrophils‐to‐lymphocytes ratio, platelets‐to‐lymphocytes ratio, red cell distribution width (RDW), and platelet distribution width (PDW). These parameters analyzed for the positive and negative appendectomy patients using statistical analysis. Results Of 200 patients included in the study, 30 patients (15%) underwent negative appendectomy. The mean neutrophils, WBC, red blood cells, neutrophils‐to‐lymphocytes, and platelets‐to‐lymphocytes ratio was significantly high among positive appendectomy patients, (P

Background: Serotonin-containing cells are abundantly found in the appendix. Studies have shown that acute appendicitis is likely to be characterized by altered urinary 5-hydroxyindole acetic acid (5-HIAA), an active serotonin metabolite. The aim of this study is to investigate the diagnostic potential of 5-HIAA as a biomarker for acute appendicitis. Method: This cross-sectional study enrolled patients referred at the Madani Hospital, with right iliac fossa pain, suspected to having the acute appendicitis. Before the initiation of the basic treatment and surgery, urine samples were obtained from the patients. Enzyme-linked immunosorbent assay (ELISA) was used for the analysis of 5-HIAA urinary levels. The obtained data were statistically analyzed using SPSS v18. Results: Of 129 patients included in the study with the mean age of 29 years, 62 (48.1%) were men and 67 (51.9%) were women. Appendectomy was performed in 96 patients, where 81 cases were that of acute appendicitis. The mean levels of 5-HIAA in acute appendicitis group and in the negative appendectomy group was not statistically significant. The sensitivity of the test was 54.3% based on 7.4 ​μmol/L as cut-off %-HIAA value. Conclusion: Our study reports that 5-HIAA urine concentration is not a reliable diagnostic marker for the diagnosis of acute appendicitis.

Background: Laryngeal fractures are one of the complications of direct damage to the neck, which can lead to airway obstruction and life-threatening conditions. Other causes of laryngeal fractures include injuries during fights, sports injuries, hangings, and iatrogenic causes. In this study, we introduce a child with a laryngeal fracture following an accidental hanging. Case Report: A 9-year-old girl was presented to the emergency department with respiratory distress and inability to speak after being hanged by her scarf. We secured the cervical spine with a hard collar and provided two intravenous (IV) lines. Then, the patient was transferred to the radiology department to perform cervical and thoracic computerized tomography (CT) scans. In the cervical CT scan, the fracture of laryngeal cartilage was detected. We repaired the fracture by prolene sutures. Then the patient was transferred to the intensive care unit (ICU) ward. After 2 days, she was transferred to ward and discharged without any complications. Conclusion: The cervical trauma is a critical condition that must be managed carefully and urgently. For the rapid diagnosis of possible damage, imaging is necessary. Among all modalities, CT scan is the best choice for detection of the vertebral injuri es and airway competence in emergent conditions.

Background and aim: Echinococcosis as a zoonosis disease is one of the most important parasitic helminth that is affected by many risk factors such as the environmental factors. Thus, we predicted the regional vulnerability to Echinococcosis based on environmental factors using a fuzzy inference system (FIS) in Lorestan Province. Methods: Our study was cross-sectional study on 200 patients from Lorestan Province (west of Iran) who underwent surgery for hydatidosis between October 2005 and November 2014. In order to model the vulnerability to Echinococcosis, first we determined the effective environmental variables. In the next step, the FIS was designed and implemented using MATLAB v.2012 software. Thus, definition and determination of linguistic variables, linguistic values, and their range were performed based on expert knowledge. Then, the membership functions of inputs (environmental variables) and output (vulnerability to Echinococcosis) were defined. A fuzzy rules base was formed. Also, the defuzzification of output was done using a centroid defuzzification function. To test the accuracy of the predictive model, we calculated the AUC (to this purpose, we used four different thresholds, 5%, 10%, 15%, and 20%) using IDRISI Selva v.17.0 software. Results: Based on the results of this study, Aligoudarz and Koohdasht counties were identified as a highest and lowest risk area in Lorestan, respectively. The results showed that a predictive model was more efficient than a random model (AUC>0.5). Also, potential vulnerable areas cover 78.29% at threshold of 5%, 60.72% at threshold of 10%, 43.54% at threshold of 15%, and 39.82% at threshold of 20% of the study area. Conclusion: According to the success of this research, we emphasized the necessity of attention to fuzzy approach to model vulnerability to hydatidosis. This approach can provide a practical economic basis for making informed preventive services decisions and the allocation of health resources.

Perforation of biliary tree will result in accumulation of bile as a collection called biloma. Post-traumatic biloma is diagnosed mostly soon after the trauma happened. We are reporting about a patient with traumatic biloma whose manifestation of symptoms appeared six months after an abdominal blunt trauma. A 65-year-old male reported with the complaint of nausea and abdominal pain since three days. On examination, a rigid abdominal mass was detected in the right upper quadrant, which was increasing in size. The patient had a record of admission in his medical history due to blunt thoracoabdominal trauma, six months ago. On laboratory investigations, there was a rise in the level of alkaline phosphatase. Computed Tomography scanning showed a fluid collection with pressure effect on liver. Emergency operation was performed for drainage and about 2 L of bile was discharged via percutaneous drainage. CT scan performed immediately after operation showed liver in the normal site and decompressed. Following-up, the patient was asymptomatic for one year. Traumatic biloma is a probable diagnosis in patients with abdominal trauma even if there is a long period of time between the incidence of trauma and the appearance of symptoms. Biloma is managed mostly by surgical methods in order to drain and find the leakage but in some cases even a percutaneous drainage can be effective.

Background: Intra operative cytology (IC), including touch imprint (TI) and crash preparations (CP), in general has been demonstrated to be a diagnostic tool for many organs but its validity and reliability for diagnosis of thyroid nodules remain controversial. We evaluate the diagnostic value of frozen section, touch imprint, crash preparation and the combination of touch imprint and crash preparation and the combination of frozen section, touch imprint and crash preparation. Materials ans Methods : 55 intra operative specimens from patients with thyroid nodules who underwent thyroidectomy were evaluated at Alzahra and vali-Asr hospital laboratories. For all of the patients frozen section (FS), touch imprint (TI) and crash preparation (CP) was obtained and reviewed by two pathologists at the same time. Serial TI and CP, and FS, TI and CP were reviewed by the same pathologists. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy were calculated according to the permanent section as the gold standard test. Results: In our study sensitivity, specificity and accuracy for FS was 100%, 97.6% and 98.1% respectively; for TI they were 78.6%, 95% and 92.4%; for CP they were 78.6%, 92.7% and 89.9%; for serial TI and CP they were 85.7%, 92.7% and 90.9%; and for the combination of FS and TI and CP they were 100%, 97.6% and 98.18% respectively. Conclusions: Intra operative cytology (including TI and CP) seems to be a useful, valuable and inexpensive method in clinics, which do not have equipment for frozen sections. Intra operative cytology combined with FS increased the overall accuracy of diagnosis. Further studies are needed to validate the obtained results of this study.