Academic Journal of Surgery

Investigation of the Frequency of Abdominal Contrast-Enhanced CT Scan Findings in Multiple Trauma Patients Presenting to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in the Year 2023

2025-01-04T09:43:02+0330

Background: Despite the importance of this issue, the evidence-based indications for CT scans in chest trauma
have not been widely investigated. This study examines the frequency of CT scan findings with abdominal
contrast in multiple trauma patients referred to the emergency department of Khatam Al Anbia Hospital in
Zahedan in 2023.
Materials and Methods: This cross-sectional study was conducted in 2023 on 191 patients who referred to
the emergency department of Khatam Al-Anbia Hospital in Zahedan with complaints of multiple traumas and
underwent contrast CT scans of the abdomen. Sampling was easy and accessible. Data collection was done by
observing the results of CT scan reports of the patients. Data were analyzed after coding in SPSS.22 software
using tests and chi-square.
Results: The average age of the patients was 44.87 ± 20.02 years, with a range of 15 to 89 years. In terms of
age distribution, 24 people (12.6%) were under 20 years old, 64 people (33.5%) were 21 to 40 years old, and
103 people (53.9%) were over 41 years old. In terms of gender distribution, 79 people were women (41.4%)
and 112 people (58.6%) were men. The most common abnormal findings were fractures in bone fragments in
35 cases (18.3%), kidney damage in 28 cases (14.6%), and liver hematoma and free intra-abdominal fluid in 18
cases (9.4%). The chi-square test showed that the findings of CT scans are significantly different according to age (P=0.039), mechanism of trauma (P=0.043), and type of clinical complaint (P=0.046).
Conclusions: The present study showed that in terms of age, normal findings are more common in individuals
under 20 years old than in other age groups, and fractures in bone fragments are more common in people over 40 years old than in other age groups. In traffic accidents, the most common findings are fractures in bone fragments, while in fights, the most common findings are related to kidney damage. In clinical complaints with blood in the urine, the most common findings are related to rupture of the spleen and kidney damage, and in complaints of abdominal pain and distension, the most common findings are related to free fluid inside the abdomen and rupture of the spleen. These results can be effective in decision-making and diagnosis.

Prevalence of Post-Traumatic Stress Disorder among Intensive Care Unit Survivors: A Prospective Study in Rasht, Iran

2025-01-04T09:43:06+0330

Background: Post-traumatic stress disorder (PTSD) is a psychological disorder resulting from a previous
traumatic experience. The objective of the present study was to investigate the prevalence of PTSD and its related risk factors among Intensive Care Unit (ICU) survivors.
Methods: A total of 152 patients were followed up prospectively for one month. All included participants had
Glasgow Coma Scale scores ranging from 12 to 15. PTSD was assessed using a Persian-translated version of the
PTSD Checklist (PCL). Data were analyzed using SPSS 22.0 software.
Results: Among the participants, seventy-two (47.4%) men and eighty (52.6%) women with a mean age of 54.5
± 19.19 years responded to the questionnaire. The prevalence of post-discharge PTSD was 87.5%. There was
a significant correlation between PTSD mean score and clinical factors such as hospitalization reason, self and
familial history of psychological disorders, and Richmond Agitation Sedation Score (RASS) (p < 0.05).
Conclusions: Our findings suggest that, despite often being ignored, post-discharge PTSD is a significant
psychological issue for ICU survivors. This highlights the importance of supportive care plans for patients with
a history of mental disorders and agitation. The involvement of psychotherapists is crucial to improving postdischarge quality of life.

The Immunology of Endometriosis and the Therapeutic Potential of Bispecific Antibodies: A Hypothesis

2025-01-04T09:43:10+0330

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrial lesions outside the uterus. Current treatment methods primarily focus on hormone-based therapy or invasive procedures. However, given the crucial role of the immune system in disease initiation and progression, there is an opportunity to explore new treatment approaches. Bispecific antibodies, which bind two different cells using their bivalent arms, have shown promise in treating cancers and autoimmune diseases. This study postulates that due to the similarities in pathogenesis between endometriosis and the aforementioned diseases, a novel therapeutic method based on this new target could be introduced. This could potentially lead to a reduction in limitations to patients' quality of life. In addition, it is important to highlight that future studies should prioritize the identification of specific binding markers on endometrial cells. This could contribute to the development of new diagnostic tools for the disease. Furthermore, the production of bispecific antibodies that selectively bind to these receptors on immune cells may prove effective in improving immune response.

The Rate of Hernia Recurrence in Surgical Patients with Mesh Repair and Non-Mesh Repair

2025-01-04T09:43:13+0330

Background: Hernia repair is one of the most common procedures in general surgery, which is performed by
various methods. One of the consequences of hernia repair is the recurrence of hernia in the short or long term. In this study, the rate of hernia recurrence in surgical patients with mesh and non-mesh repair methods was investigated.
Methods: This prospective cohort study was conducted on 138 patients who underwent repair surgery with
mesh (28 individuals) and without mesh (110 individuals) due to hernia in Hamadan Ba’ath Hospital in 2019
and 2014. The authors investigated and compared in terms of frequency of recurrence and complications. Part of the required data was obtained from the patient’s medical records and part was obtained through telephone calls. Data analysis was done with SPSS software version 26.
Results: The average age of the patients was 41.2±26.25 years, 88.4% were male and 11.6% were female.
The frequency of hernia recurrence was 3.6% in total, all of which were in the non-mesh repair group. No
significant difference was observed between hernia repair with and without mesh in terms of frequency of
recurrence (P=0.583) and complications (P=0.964). Also, no significant relationship was observed between
hernia recurrence with gender, age, smoking, employment status, and body mass index (P>0.05).
Conclusions: Hernia repair with both methods with and without meshing have a relatively favorable short-term
outcome. Although meshing reduces hernia recurrence; However, there was no significant difference between the two methods of hernia repair with and without meshing in terms of recurrence and complications.

Rapid Progressive Synovial Sarcoma of Right Knee: A Rare Case Presentation

2025-01-04T09:43:16+0330

Background: Synovial sarcoma is a rare malignant soft tissue tumor that commonly emerges in the para-articular area, with the knee as the predominant location. The preferred intervention for this tumor is still currently debated
Case description: We presented a 29-year-old male with a very large mass in the right knee. The physical examination revealed impairment of the right lower extremities, particularly the knee. MRI confirmed the extent of the pathology, but the first pathology analysis was inconclusive. A wide resection was performed without prior neoadjuvant therapy. The second pathology analysis from the resected tissue confirmed the diagnosis of biphasictype synovial sarcoma. The patient was able to walk with no assistance, had an increased range of motion, and the utmost preservation of the limb.
Conclusions: We presented a successful case of wide resection of synovial sarcoma with a promising clinical
outcome. The complexity of the case leads to the need for a tailored approach that should be limited to
musculoskeletal oncologists.

Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review

2025-01-04T09:43:19+0330

Background: Renal cell carcinoma (RCC) is a malignancy known for its high metastatic potential, commonly
spreading to the lungs, bones, brain, liver, and adrenal glands. Gallbladder metastasis from RCC is exceedingly
rare and poses significant diagnostic challenges due to its asymptomatic nature and nonspecific imaging findings.
Case Presentation: We report the case of a 58-year-old Persian man with a history of clear cell RCC treated
with left radical nephrectomy 34 months prior. The patient presented with right upper quadrant abdominal pain. Imaging studies, including contrast-enhanced computed tomography and ultrasound, revealed two hypervascular polypoid lesions within the gallbladder. An open cholecystectomy was performed due to the suspicion of malignancy. Histopathological examination confirmed metastatic clear cell RCC invading the gallbladder wall. Notably, immunohistochemical analysis showed tumor cells positive for cytokeratin 19, alpha-methylacyl- CoA racemase, and vimentin, but negative for paired box gene 8, cytokeratin 7, cytokeratin 20, and cluster of differentiation 117 (C-Kit). The absence of paired box gene 8 expression is atypical for RCC metastasis and posed a diagnostic challenge. The patient had an uneventful postoperative recovery but unfortunately passed away two months later due to a cerebrovascular accident unrelated to his oncological condition.
Conclusions: This case underscores the importance of considering gallbladder metastasis in the differential
diagnosis for patients with a history of RCC presenting with gallbladder lesions. The atypical immunohistochemical profile observed expands the known spectrum of metastatic RCC presentations and highlights the necessity for comprehensive diagnostic evaluation. Surgical intervention through cholecystectomy can lead to favorable outcomes and should be considered in similar cases.