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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.

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.

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.

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.