Background: Ghost ileostomy is a new invented method that use in patients with low ant resection and colorectal anastomose. Ghost ileostomy can be used instead of converting stoma. CS (converting stoma) is critical after low rectal resection procedures due to its anastomosis leakage preventing role, especially in patients who are at higher risk but its complications are non-negligible. We approached a study of Ghost ileostomy to identify its probable post operation morbidity and mortality. The purpose of this study was to assess the prevalence of some Post operation morbidity such as anastomose bleeding or hematoma, prolong ileus, pulmonary emboly, intra abdominal abscess, wound site infection and other complications.
Methods: 26 patients with low ant resection and colorectal anastomosis due to colon cancer without any risk factor between 2013 and 2014 were selected. Checking of anastomosis leakage after 10-14 days post operation was analyzed to assess the prevalence of anastomosis leakage and compare post operation morbidity and mortality.
Results: The mean age of cases was 55 years (40 to 65). 16 (61.5%) were male and 10 (38.5%) female. average BMI is 23.7 and all of the patient are in the normal range. Our mortality rate was negative. 2 patients (0.076%) suffered from prolong ileus and one patient (0.038%) had wound site infection. Other post operation morbidities such as anastomose bleeding or hematoma, pulmonary emboly, intra abdominal abscess were negative. We had no any stoma related morbidity and also no any anastomosis morbidity.
Conclusion: Anastomosis leakage is the most complication in colorectal surgeries. Diverting stoma can decrease complications of anastomosis leakage but there is no evidence of its preventing role. By using ghost ileostomy we can manage selective loop ileostomy and the complications will be reduced. The most reliable way for anastomosis leakage diagnosis is surgeon's suspicion. Converting stoma that use for preventing anastomosis leakage, has significant complications by its own. As the anastomosis leakage does not have a high prevalence we can use ghost ileostomy to reduce the complications and improving quality of life.

Introduction:  Every year, many chronic kidney disease (CKD) patients undergo surgeries to provide suitable vessel access for hemodialysis. These surgeries cause remarkable anxiety in these patients. Therefore, this study was conducted to examine the effectiveness of nurse-led training on the level of anxiety experienced by these patients.
Methods: 38 cases were randomly selected from the candidates for opening vascular access in Shariati hospital, Tehran, Iran.  Divided equally into two groups of cases and controls, the anxiety rate was measured in both groups using the Spielberger state-trait anxiety inventory at baseline. After 30 minutes of our special personalized training, the anxiety rate was reevaluated in cases and, using paired t-test, was statistically compared with the anxiety rate before the intervention.
Results: The mean baseline anxiety rate was 40.94 and 40.42 in cases and controls, respectively. These numbers altered to 34.78 in cases and 40.05 in the controls after the training intervention. Statistical comparison yielded a significant decrease in the case group (p = 0.048), while the observed difference was statistically insignificant in the controls (p = 0.788).
Conclusion:  providing an appropriate personalized nurse-led educational package can remarkably reduce the anxiety level in preoperative candidates for opening vascular access in kidney failure cases. Further studies are required to better develop the content of these training and also to define whether a gap between the training and surgery is required to increase the effectiveness.

Introduction: Trauma ranks as the fourth leading cause of mortality worldwide. Evaluating the consciousness levels of trauma patients involves a range of tools, among which the Glasgow Coma Scale (GCS) holds paramount importance. The GCS is a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. To this end, the study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS.
Methods: This cross-sectional descriptive-analytical study investigated 200 brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients' consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists have determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS 22, were employed to examine the relationship between consciousness levels and CT scan results.
Results: Three out of 200 patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was 27.94 ± 11.25. Results showed that 67.5% of all patients survived, while 32.4% succumbed to injuries. The initial GCS score was 14-15 for 83 patients (42.1%), 9-13 for 69 patients (35%), and 3-8 for 45 patients (22.8%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in 48 patients (24.3%). In the examination of the relationship between the mechanism of brain trauma and mortality, 75% of patients involved in falls and 65.5% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=0.318). Furthermore, all patients with a GCS score of 14-15 (100%), 85.6% with a GCS score of 9-13, and 35.5% with a GCS score of 3-8 survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=0.001). Statistical analysis indicated that 66.7% of patients with subdural hematomas, 75% with epidural hematomas, 81% with cerebral contusions, 35.3% with intracerebral hemorrhages (ICH), and 92.3% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=0.01). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of 64.7%.
Conclusion: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient's treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality.

Increasing incidence rate of breast cancer in young women obligates investigations of clinical and pathological features in this age group. Less hormone receptor expressions and more aggressive behavior has been discussed in very young breast cancer patients. In this study pathological data of patients diagnosed with Invasive ductal carcinoma referred to Shariati hospital and Tehran cancer institute between 2015 and 2018 was evaluated in two groups : under 35 years old (Group1) and above (Group2). Each group contained 156 cases.  62.8% and 63.5% Estrogen and Progesterone Receptor expressionwas reported in Group 1 in comparison to 77.6% and 74.4% in Group 2 ( P value= 0.004 and 0.0038). Her2 expression was found in 41% and 21.2% in group 1 and 2 respectively ( P value= 0.0001). There was  41.2 ± 25.2 and 29.6 ± 21.7 reported of Ki67 in Group 1 and 2 ( P value= 0.001). In conclusion negative hormone receptor, positive Her2 expression and higher proliferation rates is found in breast cancer patients under 35-year-old

Central venous catheters (CVCs) are primarily used in oncology to protect peripheral veins and provide effective access to chemotherapy. This study investigated the results of in-plane ultrasound-guided imaging compared to out-of-plane imaging in patients with oncology-related CVC placement in the oncology department of Shariati Hospital in Tehran.
Methods: This cross-sectional analytical study was conducted on 50 eligible oncology patients over 6 months in 1400 at Shariati Hospital in Tehran. The patients were randomly divided into two groups: in-plane and out-of-plane, and the internal jugular venous catheter was inserted by using one of the methods above by an anesthesiologist. The necessary variables for statistical analysis were collected using predetermined questionnaires.
Results: The mean age of the patients was 73.42 years, with 25 female participants. The catheter insertion was successfully performed in all patients. The mean duration of catheter insertion in the study population was 2.289 seconds, the mean number of skin punctures was 1.7, and catheter placement was successful in 62% of patients on the first attempt. A total of 23 complications occurred, with carotid artery puncture being the most common—the catheterization method, whether in-plane or out-of-plane, did not affect the initial success of catheter insertion.
Conclusion: According to the findings of this study, internal jugular vein catheterization was successfully performed using both in-plane and out-of-plane methods with similar results. 

The Fujimori gate flap is known and used for the reconstruction of defects resulting from oncologic surgery. This case report describes the use of this flap to reconstruct the upper lip of a patient who had a defect following lip carcinoma, resulting in a loss of 2/3 of the upper lip tissue. The case involves a 34-year-old woman presenting a partial lip defect after upper lip carcinoma. She underwent a unilateral gate flap procedure, which allowed the authors to reconstruct the three levels of skin, muscle, and mucosa. Following surgery, no complications were observed. The patient was followed up at three months and a year later. She was able to speak and chew without  any trouble after the flap restored oral competency. The patient’s treatment objectives, which included regaining oral competency and achieving an acceptable aesthetic result, were met thanks to the use of the Fujimori gate flap in this case. Compared to the use of other local, regional, or remote flaps, the flap also provides good color matching. The Fujimori flap ensures the restoration of the oral sphincter, in contrast to the typical flaps used to reconstruct the upper and lower lip, thereby promoting oral competence.