فهرست مطالب سیدهادی میرهاشمی

Early detection plays a vital role in improving the outcomes of patients with gastric cancer. However, identifying the disease during its early stages is challenging due to the lack of specific symptoms.

Presentation of Case: 

This case report presents a patient with gastric cancer and liver metastasis who remained asymptomatic despite the advanced disease. The patient initially presented with acute abdominal right upper quadrant pain, leading to various diagnostic investigations, including ultrasound, CT scan, MRI, and upper gastrointestinal endoscopy. The imaging and pathological findings confirmed the presence of a metastatic liver mass and a large fungating mass in the stomach with the pathology of an adenocarcinoma after endoscopic biopsy. Surgical intervention was avoided due to distant metastasis. The patient underwent FOLFOX (folinic acid, fluorouracil and oxaliplatin) chemotherapy regimen.

This case highlights the importance of considering gastric cancer in the differential diagnosis of patients presenting with unexplained abdominal pain without typical symptoms.

A multidisciplinary approach involving various medical specialties is necessary to ensure early diagnosis and appropriate treatment for metastatic gastric cancer.

The use of burning substances is common in our country. Burns caused by the ingestion of caustic substances are potentially one of the most debilitating injuries of the industrial, which can place a great burden on the patient and the health system.To diagnose and treat these patients, it is necessary for surgeon from different fields to cooperate, including surgeons, gastroenterologists, otolaryngologists, and radiologists. Delay in the diagnosis and treatment of full-thickness necrosis of the esophagus and stomach is one of the important factors in the prognosis of patients In fact, the amount of delay in surgery can be considered as a predictor of mortality in these patients. Ingestion of caustic substances leads to tissue damage within the first few seconds. At the beginning of the disease, bleeding, thrombosis and inflammation with edema are the dominant tissue processes. Severe burns can lead to focal areas of necrosis with the risk of perforation. Routinely, after conducting preliminary investigations and in the absence of clear signs of respiratory distress and clinical symptoms of the neck, chest and abdomen, it is recommended to perform an endoscopy in the first 24 hours, and based on the results of the endoscopy, the necessary treatment decision is made. The diversity in the existing guidelines in this field and the relatively uncommon occurrences in medical centers are the reason for the lack of a fixed protocol in the treatment of these patients. For this reason, treatment methods in many centers are different from each other.

Gastric cancer, a significant global health concern, presents unique challenges when it occurs within families due to potential genetic predisposition. This article presents a case series of three gastric cancer cases in a family and discusses their clinical characteristics, management, and outcomes. The first case involved a 35-year-old female patient who underwent surgery with no recurrence during follow-up. The second case, her younger brother, experienced recurrence and post-op complication leading to death. The third case, their mother, presented with metastatic gastric cancer. The article emphasizes the rarity of hereditary gastric cancer and the need for further research and guidelines in its diagnosis and treatment. Genetic testing's role in identifying familial gastric cancer remains uncertain but warrants improvement in disease management, family monitoring, and preventive interventions.

Along with the advancement of medical knowledge and increasing life expectancy, the number of complicated surgical operations in people with underlying diseases has also increased a lot. It seems that providing a practical guideline for improving the quality of surgical operation will lead to reduce of complications of surgery and quickly return of patient to community, in which this program presented by a group of academic surgeons in the name of Enhanced Recovery After Surgery (ERAS) in 2001 and in London.
ERAS, is a multimodal and multidisciplinary approach for caring the patients who has underwented surgery. There are some evidences that in case of successful implementation of ERAS protocols, not only the quality of treatment and surgery improved but also it caused to reducing the length of stay of patient at hospital and its cost accordingly.
So we decided to introduce this program by reviewing its background, existential philosophy, teams, implementation and achievements of running ERAS.

Necrotizing fasciitis is a very rare presentation of sigmoid colon diverticulitis. An 80 year-old male presented with an abdominal pain that started 4 days ago and was accompanied by fever¡ chills¡ distention and erythema in the lower quadrants of the abdomen. On examination erythema¡ subcutaneous emphysema and crepitation were present over his lower regions of the abdomen. CT scan revealed sigmoid colon diverticulitis with stranding fat tissue and extended density of free air in the subcutaneous soft tissue of anterior abdominal wall. The patient was started on antibiotics and underwent an aggressive debridement of devitalized tissues. The wound closed by advancement flap with local anesthesia 2 months after surgery and the patient underwent sigmoid colectomy 3 month later. Despite the rarity of such cases¡ gastrointestinal pathologies should always be considered in patients presenting with abdominal wall necrotizing fasciitis.

Despite the high prevalence of blunt abdominal trauma, traumatic abdominal wall hernia (TAWH) is rare. The mechanism of injury can be severe such as a motor vehicle accident or relatively minor such as a fall onto a bicycle handlebar. In children TAWH can occur even after relatively minor trauma and these cases typically have no associated intra abdominal injury. We report a traumatic hernia of abdominal wall in 9 years old boy following a fall from bicycle. The presence of circular skin bruising, localized tenderness, and a reducible swelling suggest the diagnosis at admission. After 2 hour he had generalized abdominal tenderness with rebound tenderness. In laparatomy through and through perforation of stomach in antral portion is repaired in two layer and primary repair of abdominal wall hernia is performed layer by layer.

laparoscopy is a novel surgical method and has became the gold standard of treatment in some diseases. Development of hernia in laparoscopic port sites is a major complication. repairing port sites has always been of concern because of their small sizes which may lead to intestinal, omentum and intra-abdominal organs damage. This study aims to investigate the effects of fascial closure on development of incisional hernia in 10 mm trochars sites. 170 candidates of laparoscopy surgery that were referred to Loghman Hakim hospital were randomly allocated in two groups: 1) fascial closure performed in 10 mm trochars sites 2) fascial closure not performed in 10 mm trocar sites. Patients followed at 3, 6 and 12 months after surgery. signs and symptoms of incisional hernia Were closely controlled and sonographic evaluation performed in suspected cases. Data were analyzed using SPSS version 16; t-test and chi2 for quantitative and qualitative variables, respectively. 10 patients where lost to follow-up. patients were matched for age,sex,BMI, existence of Diabetes mellitus and anemia. incidence of incisional hernia in group one and two were 2.5% VS 1.25%. this difference was not statistically significant. it is highly probable that closure and non-closure of facia does not affect the incidence of incisional hernia in 10mm trocar sites.

Ileosigmoid knotting occurs when the ileum wraps around the base of an elongated sigmoid colon, thus producing two closed-loop obstructions, with the possibility of ischemia and necrosis of either the ileum or sigmoid colon. Because of low incidence of the disease and its rapid progression to bowel gangrene, the diagnosis of the disease occurs late for most patients. ISK is more common in adults, with peak of its occurrence in 4th decade of life. A 32 years male patient with sudden onset abdominal pain which lasted for 12 hours, was operated by provisional diagnosis of acute of abdomen. Exploratory laparatomy revealed torsion of ileum around the sigmoid colon along with the gangrene of both of them. Resection of small bowel, with primary anastomosis, sigmoidectomy with end colostomy plus Hartman pouch was performed. Finally colostomy closed after 6 months.

Caustic or corrosive caustic substance is a chemical substance that damages the tissue with which it comes to contact. These materials include domestic and industrial caustic. Treatment of chemical burns of the esophagus and stomach is one of the greatest problems in surgery; the studies to date have not proved specific results despite various medical and surgical procedures

Due to some previous convincing results of stenting, in this survey we studied the patients who presented to Loghman Hospital from 2000 to 2010 complaining of caustic ingestion and underwent stenting. The patients were followed for a period of 1 year.

Among the 35 patients, 18 patients (51.4%) didn’t have any stenosis on imaging or examination, 5 cases (14.3%) developed Gastric Outlet Obstraction(GOO), in 2 patients (5.7%) we diagnosed esophageal stricture, unfortunately 6 patients (17.1%) died, and we did not find anything about the fate of 4 (11.4%).

In this review we concluded that the use of stents in patients with esophageal caustic burns, especially in those with endoscopic Grade 2A burns, is effective the incidence of Esophagus stenosis.

Introduction & Splenic abscess is an uncommon disease. Because of the increase in immunocompromised cases it is thought that its prevalence is growing up. Due to its nonspecific presentations، the diagnosis of splenic abscess can be difficult and in case of fever، chill، LUQ pain and leukocytosis، specially in immunocompromised patients، it must be considered. During a 16-years period، 12 patients with splenic abscess، who were admitted to Loghman hospital، were analyzed epidemiologically and their clinical and paraclinical findings were studied. The most common clinical finding was abdominal pain that was present in all patients and the most common paraclinical finding was leukocytosis and anemia. The most common underlying factor for splenic abscess was immunodeficiency (IV drug addiction). Considering nonspecific signs and symptoms، including fever and abdominal، pain in immunocompromised patients and applying appropriate imaging studies like CT scan can lead to on-time diagnosis and treatment.

Introduction & Breast cancer is a fatal disease that causes morbidity and mortality in women worldwide. Assessment tools for the risk of breast cancer are widely used for counseling and determining eligibility for breast cancer. The usefulness of these tools in the case of Iranian women is uncertain. So we decided to use Gail model for predicting absolute risk of invasive breast cancer in women who refer to health centers of Yasuj، Iran. In a cross sectional study، we used data from 513 women who were referred for routine woman health programs in Yasuj health centers، during 2010-2011. Age، marriage status، age of marriage، pregnancy and menopausal history and Gail Model results for these people was determined. T-test and Anova were used in the evaluation of the averages and SPSS 15 software was used for the analysis. The mean of age of this group was 41. 8+6. 1 years. The risk of breast cancer in the next five years (5R) was 0. 55% and the risk of breast cancer during the whole life (LTR) was found to be 8. 2%. 14 women (2. 7%; CI 95%: 1. 1-8. 5) had high risk of breast cancer، based on Gail Method. Mamography and sonography were normal in these women. Based on Gail model، the risk of breast cancer in these women was determined to be 2. 7%. More studies for the rest of the population are necessary for a final judgment.

Introduction & Bowel mechanical preparation is a routine procedure before colorectal surgeries. Anorectal procedures are most prevalent procedures in general surgery. To reduce risk of infection and better performance, all authors insist on bowel preparation before anorectal surgeries. The aim of this study is the comparison of the mechanical bowel preparation with polyethylenglycol (PEG), saline enema or no prep before anorectal surgery (hemorrhoid and fistula). In a randomized clinical trial 150 cases of candidates for elective hemorrhoid or fistula in general surgery ward of hospital enrolled came under study: 50cases in PEG group (1), 50 cases in saline enema (2) and 50 cases with no prep or control (3). After surgery surgeon's satisfaction, pain after first defecation and post operative complications were evaluated and analyzed by SPSS 16, ANOVA and chi-square test. The mean of age, gender and procedure type were not different significantly between groups. Surgeon's satisfaction was 26% in group 1, 28% in group 2 and 0% in group 3; difference was significant (P-value.

Benign multicystic abdominal mesothelioma is a rare tumor that occurs mainly in women in their reproductive age. To date 130 cases have been reported. It is characterized by the formation of multilocular cysts with thin-walled that frequently appears as large, intraabdominal masses. When tumor appears in the abdominal cavity, it attaches to intra-peritoneal organs like intestine and omentum, spleen, liver or progress toward retroperitoneal organs such as pancreas. Differentiation from other cystic lesions could be only with histologic study and surgery is mandatory for diagnosis and treatment. In this study we report a case of 52-year-old woman with 20×15cm abdominal mass that undergone surgery. Histopathological examination revealed a multicystic mesothelioma with retroperitoneal progression.

Most ingested foreign bodies pass through the gastrointestinal tract without a problem. Occasionally complications like obstruction and hallow viscus perforation occurs. Duodenal perforation due to foreign body ingestion is not common and observation is enough for most cases, but if it is long with sharp margins, especial consideration for its early removal with endoscopic intervention is needed. This could be true for long foreign bodies with blunt ends. Otherwise severe complications may occur, like our case study. The patient is a 3.5 years old boy come to emergency ward with complaint about generalized abdominal pain for 3 days ago with nausea and vomiting and normal defecation. The patient underwent laparatomy because of generalized tenderness and intraperitoneal free air; and there was a duodenal perforation in duodenojejunal junction due to foreign body and it was repaired with omental patch. The aim of this report is to attract especial attention to log ingested foreign bodies even with blunt end.