فهرست مطالب zakiyeh jafaryparvar

Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. Hepatic artery pseudoaneurysm is a rare complication of bile duct injury. Rupture is accompanied by abdominal pain, intraperitoneal bleeding, jaundice, and gastrointestinal bleeding (GIB). In this study, we introduce a patient who underwent laparoscopic cholecystectomy. During the laparoscopic operation the patient needed open surgery due to bleeding; and a month later, the patient presented with massive upper gastrointestinal bleeding.

The patient was a 43-year-old woman with a history of laparoscopic cholecystectomy one month before. She presented with complaints of abdominal pain and hematemesis. Gastrointestinal endoscopy showed duodenal bulb erosion, and computed tomography (CT) scan showed evidence in favor of hepatic artery pseudoaneurysm. The patient underwent emergency laparotomy due to hemorrhagic shock. Hematoma and pseudoaneurysm of the right hepatic artery from superior mesenteric artery were seen in the exploration. The exploration of subhepatic hematoma, hepatic artery repair, and abdominal cavity drainage was done. A few days after the operation, the patient was discharged in good general condition, stable vital sign, normal laboratory tests, and PO tolerance. There was no complication in one month follow-up.

Vascular injuries are rare complications in patients undergoing cholecystectomy, and its manifestation as UGIB is very rare. Due to its high morbidity and mortality, it should be evaluated and treated as soon as possible.

Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.

We aimed to examine the atherosclerotic patterns of lower limb arteries in patients with diabetes mellitus undergoing angiography in Razi hospital, Rasht, Iran, in 2016.

In this retrospective cross-sectional study, patients with diabetes mellitus underwent angiography in an endovascular surgery center in Razi Hospital in Rasht in 2016, were evaluated. Demographic characteristics, disease-related factors, and angiographic findings were recorded. Proximal Pattern in this study was defined as significant involvement of suprageniculate arteries, and the distal pattern was defined as significant involvement of infrageniculate arteries. The extent of vascular involvement in this study was measured by trans-atlantic inter-society consensus 2 (TASC2) scale.

169 patients were included in this study. 60.9% of the patients were men, and the average age was 64.34 ± 10.26 years. Chief complaint in 58% of the patients was non-healing ulcer (58.0%). 47.3% of the patients had dyslipidemia, 65.1% had hypertension, and 22.5% of them had no other underlying diseases. 24.3% of the patients were smokers. In general, in 62.7% of all patients, the pattern of atherosclerotic involvement was distal. There was no significant relation between atherosclerotic involvement pattern and sex, body mass index (BMI) range, history of renal disease, or dyslipidemia.

The findings showed that the most prevalent pattern of atherosclerotic vascular involvement in patients with diabetes mellitus was distal pattern. There was no significant relationship between atherosclerotic pattern and sex, BMI, history of renal disease, and dyslipidemia.

Despite extensive studies on prevention and management of deep vein thrombosis (DVT), less attention has been paid to chronic venous insufficiency. The persend study aimed to investegite the incidence and clinical signs of post thrombotic syndrome in patients with deep vein thrombosis.

A descriptive retrospective study was done in patients with DVT from 2010 to 2013 in Rasht, Iran. Informed written consent was taken from the patients who were willing to participate in this research and photolithography was performed. Demographic and clinical information, underlying diseases, and photolithography results were recorded.

A total of 153 lower limbs was evaluated (mean age of the patients: 14 ± 50 years). In most of the samples, the DVT involvement was iliofemoral (43.1%) and the mean time from developing DVT was 2.8 ± 0.83 years. In these patients, the most common symptoms were edema (66%), telangiectasia (47.7%), and pain (43.8%). The majority of the patients had impaired photoplaciographic scores (94.8%). Post-thrombotic syndrome (PTS) was seen in 37 cases (24.19%). There was no significant correlation between incidence of PTS and occurrence of DVT and therapeutic methods.

Understanding the epidemiology, clinical signs of DVT, and follow-up of its complications can be helpful in making appropriate diagnosis and treatment of these patients. In current study, the abundance of PTS was not great, but, edema, telangiectasia, and pain were obseved in most of the patients.

The incidence of melanoma has remarkably increased over the last years. It commonly involves the extremities in females and the trunk in males. Cutaneous malignant melanoma (CMM) of the breast accounts for less than 5% of all melanomas.

A 60-year-old man referred with a black pigmented skin lesion (4 × 2 cm) on the periareolar skin in the upper inner quadrant of the right breast without nipple retraction. The patient mentioned that he failed medical follow-up of the lesion, which had been excised for about a year in 2016 as a CMM that resulted in its rapid growth. Examinations revealed a mole (4 cm) on the right areola and also a palpable axillary lymph node. Incisional biopsy reported malignant melanoma. After final confirmation, he underwent a modified mastectomy. The pathology report revealed that nipple and areolae were free of tumor, however, a deep margin and two axillary lymph nodes were involved, which resulted in considered adjuvant radiotherapy. Two months after the surgery, his health condition was normal without any sign of recurrent metastasis.

In this case, the modified mastectomy was inevitably done and no recurrence or complication was observed.

The advances in the field of burn treatment resulted in increased survival of burn patients, which led to increased attention to the issues associated with the quality of life. The assessment of the quality of life and the associated factors might help in identifying the needs of affected patients and designing suitable therapeutic and supportive programs.
The present study aimed to determine the quality of life and the associated factors in patients suffering from burns hospitalized at the subspecialty burn and plastic surgery center in Rasht city.
The present cross-sectional analytical study consisted of 60 burns patients collected through systematic random sampling. The instrument used included Burn-Specific Health Scale-Brief (BSHS-B) along with a questionnaire for recording the demographic information as well as the complications and problems after the burn (itching, hypertrophic scar, colloid, hypopigmentation, and hyperpigmentation). The data were analyzed by descriptive statistics (frequency estimation, mean, and standard deviation) and inferential statistical tests (Friedman and linear regression tests).
The mean post-burn quality-of-life total score was 76.9±20.74; the patients presented substantial problems regarding heat sensitivity of the burnt site (61.75%), and the extent of burns was a predictive factor of the quality of life [P=0.0001, 95% Confidence Interval (CI)=-1.65 to -0.6, B=-1.133].
Despite the advances achieved in treating patients with burns, the subsequent problems and complications are yet challenging. Also, the low-degree burns can be considered as a factor affecting the quality of life of these patients.