Journal of Iranian Medical Council
Volume:6 Issue: 4, Autumn 2023

Dr. Abdulkarim Vessal was a distinguished professor of the Shiraz Medical School in south of Iran. He was born in 1933 in Shiraz. After finishing primary and high schools, he went to Germany and entered the Ludwig Maximilian University of Munich in 1957, where he studied medicine and received his MD degree (Figures 1 and 2) (1).In due course, since he was highly interested in basic science, he studied physics at the Berlin School of Science and Philosophy up to 1961 and then continued his medical training in radiology at the Berlin University and in 1965, he obtained the board certificate and practiced for few years in Germany and England and finally he returned home. In Shiraz, Dr. Vessal joined the Shiraz School of Medicine as an Associate Professor and became the Head of Radiology Department. Later, he went to the USA and continued his training in radiology at the Johns Hopkins Radiology Department as well as Vanderbilt University (1).Dr. Vessal became Professor of Radiology in 1976, a duty that continued for 40 years. He attended several international and local scientific meetings and delivered remarkable lectures (Figure 3). He was a member of Radiology Board Examination. In addition to his educational and research efforts, Dr. Vessal wrote 46 English papers in sound medical journals which are available at the PubMed database. He together with Dr. Reza Habibian also authored the first comprehensive Persian textbook on nuclear medicine, which was published by Shiraz University Press in 1976 (2).

The global COVID-19 pandemic has left a substantial mark on society, affecting millions of lives and triggering widespread disruption. Beyond the immediate health implications, emerging evidence suggests that recovering individuals may face long-term cardiovascular complications (1-3). As we cautiously emerge from the crisis, it is crucial to shift our focus from the acute phase to the post-COVID-19 period. This editorial aims to shed light on the importance of recognizing and addressing the cardiovascular complications associated with COVID-19 recovery, highlighting the need for enhanced medical care, research, and public awareness.

 This study explains the lineage in embryo donation and the inheritance of born children. This study was conducted with a library, descriptive and analytical design, relying on books of jurisprudence and laws of Shia and other Islamic religions, as well as citing some legal studies. Under Ayatollah Khamenei’s original fatwa in 1990, which permitted gamete donation by third parties. This legal approach paved the way for the adoption of the Embryo Donation to Infertile Spouses Act in 2003. The embryos formed from a man’s sperm and the ovum of his legitimate wife, with any methods of embryo formation and its transfer to the aforementioned man and woman, have a legitimate lineage and there will be no problem in the inheritance for the baby. However, the embryos formed from the sperm of another man (other than a legal husband) or the egg of another woman (other than a legal wife) regardless of the method (natural or artificial) will not have legitimate lineage, and as a result, donated children are deprived of inheritance. To ensure the financial future of children born through embryo donation, solutions such as an official will or using the life insurance industry can be considered as a temporary solution. However, it is necessary to review the embryo donation law by religious and legislative authorities.

Oral lesions consist of ulcerations, red-white lesions, pigmentations, and exophytic lesions. Exophytic lesions include swellings that project over the normal contours of the mucosa. In addition to a swelling’s surface texture, the type of base, and consistency, its location is also of significant importance in limiting the differential diagnosis and reducing the time needed to achieve it in some cases. According to the literature, one of the locations whose lesions are not readily and quickly diagnosed is the palate. Our review of the PubMed/MEDLINE, Scopus, and Google Scholar databases revealed that the lesions of the posterolateral portion of the palate, which account for the majority of the palate’s lesions, can be divided into four main categories, including 1) odontogenic infections or dental abscesses, 2) salivary gland neoplasms, 3) palatal mesenchymal tumors, and 4) maxillary sinus malignancies, which are discussed in this study. When clinicians face a swelling located at the palate’s posterolateral segment, they should consider the abovementioned entities as the most probable differential diagnosis, respectively.

COVID-19 changed the global view of education in less than a few weeks and changed how students are taught worldwide. Online education, while having many advantages, also brings limitations and problems for some students. Therefore, this study was conducted to investigate the “level of concentration” and “full presence in the class” of perfectionist students in online education among the exceptionally talented students of the higher secondary school in Iran. This cross-sectional study was performed on 100 randomly selected exceptionally talented students of a higher secondary school in Karaj, Iran. The research tools included perfectionism and concentration skill questionnaires that were provided to students online. The findings showed no significant difference in the class’s level of concentration and full presence between students with different degrees of perfectionism (p=0.514 and p=0.247, respectively). However, due to the technical problems of online classrooms, 64% of students with high perfectionism were fully present in the classroom in less than 30 min. This rate was 47% for students with low perfectionism. It seems that due to the difference between face-to-face and virtual learning environments, holding online classes along with determining and setting the topics of lessons and training hours differently from face-to-face classes and shorter and more concise in creating an interactive atmosphere may be more useful.

Deaths associated with the Acute Coronary Syndrome (ACS) remain high among Cardiac/Coronary Care Unit (CCU) and post-CCU patients. Recently, researchers have looked for inexpensive and reliable prognostic indicators as alternatives to the expensive pro-Brain Natriuretic Peptide (proBNP) in ACS patients to predict adverse outcomes. We retrieved the Complete Blood Count (CBC) records of ACS patients and calculated values for plateletcrit (PCT), Mean Platelet Volume (MPV), and Neutrophil-to-Lymphocyte Ratio (NLR). We also recorded ACS diagnostic methods, duration of hospital stays (CCU and post-CCU), and therapeutic modalities. We considered outcomes such as death, positive or negative troponin, ST-elevation, ejection fraction <45, and history of arrhythmia. The multivariate model using forward stepwise logistic regression showed that the history of arrhythmia (OR=124.052, p= 0.001), positive troponin (OR=47.545, p=0.002), hospitalization period (OR=2.376, p=0.001), C-reactive protein (CRP) (OR=1.359, p=0.001), and PCT (OR=2.018, p=0.001) are independent predictors of mortality. CRP and PCT are considered independent predictors of mortality among CCU and post-CCU patients diagnosed with ACS. However, the prognostic significance of NLR and MPV needs to be confirmed by further investigations.

Substance use disorders are a significant global public health issue, causing considerable suffering, trauma, and financial burden. With the increasing prevalence of drug use and its detrimental consequences, it is crucial to identify predictors and implement preventive measures to address these problems. The main aim of the present study was to test the utility of the Theory of Planned Behaviour (TPB) to predict university students’ illicit drug use intentions in the Indian context.

The study used a cross-sectional research design and included a sample of 1254 students (male=473, female=781) aged 15-29 (Median age=22.61). Participants completed the measures of attitude, perceived norms, refusal self-efficacy and drug use intentions. Structural Equation Modeling was utilised to analyse the effectiveness of TPB constructs to predict university students’ drug use intentions.

The results indicated that positive attitude and perceived norms were positively related with drug use intentions, while refusal self-efficacy was negatively related. The proposed model accounted for (30%) of the variance in students’ illicit drug use intentions. The analysis of Regression weight estimates and critical ratios represented that the perceived norms and perceived behavioural control significantly predicted drug use intention. However, contrary to expectations, attitude did not predict drug use intentions.

The findings of the present study highlighted the usefulness of TPB in predicting drug use intentions in the Indian context. These findings will benefit drug use intervention programmes.

Fragmented QRS (fQRS) on electrocardiography is a marker of myocardial fibrosis and scar formation. We aimed to investigate whether the fQRS complex in children with and without obesity correlates with Body Mass Index (BMI). In this cross-sectional study, 104 children (5 to 17 years) referred to the pediatric clinic were studied. We divided participants into normal and obese groups. Standard 12-lead ECGs, anthropometric data, and blood pressure were recorded. All ECGs were analyzed blindly by two independent clinicians. Surveyed parameters of the ECG included heart rate, QRS duration, QT interval, presence of Q waves, and fQRS. Among 104 participants, 52 patients had normal BMI and 52 cases were obese. Systolic blood pressure (p=0.001), pulse pressure (p=0.007), mean blood pressure (p=0.006), and heart rate (p=0.009) were meaningfully different between the two groups. We found fQRS in four children with obesity. The frequency of fQRS was significantly different between children with obesity and children in the control group (p=0.041). We have found that each unit change of weight and BMI at 1.07 and 1.45, respectively, could be useful in prediction of the occurrence of fQRS complex in children. This study suggested a significant association between the fQRS in children’s ECG and their weight and BMI. It would appear that each unit increasing weight and BMI predicts an increasing the occurrence of fQRS. The ECG may consider using fQRS as a cardiac risk marker in children with obesity.

In current study, we aimed to investigate if Attention Deficit Hyperactivity Disorder (ADHD) is better to be categorized among behavioral or neurodevelopmental disorders, based on some familial and environmental factors. 

We conducted correlation analysis to identify psychiatric disorders in the dataset which have an important impact on ADHD. Also, we used machine learning-based approaches combined with a feature selection algorithm to cluster and classify ADHD as a behavioral or neurodevelopmental disorder.

Model evaluation showed that ADHD is clustered in the group of behavioral disorders with the accuracy of 78%. Furthermore, Support Vector Machine (SVM) classified ADHD as a behavioral disorder with the accuracy of 72.66% and as a neurodevelopmental disorder with the accuracy of 60.07%.

In sum, we can say that our findings support categorizations systems like HiTOP in comparison to DSM-5. However, as biological factors were not included in our analysis, it should be considered with caution and examined in future researches.

Sedentary life style may affect dental health, growth, and general well-being of children, requiring the participation of health care providers. The aim of the present study was to assess the relation between oral health (dental plaque index) and sedentary lifestyle pattern in children. In this cross-sectional and descriptive-analytical study, 219 children aged 8 to 12 from the schools of Shahrekord city were selected by cluster random sampling in 2021–2022. After obtaining informed consent, parents filled a questionnaire about their child lifestyle pattern. Children chew disclosing agent and then Plaque index was recorded by examination according to tooth coloring pattern. Data were analyzed using Spearman correlation coefficient, K-square in SPSS 22 software. The level of significance was considered less than 0.05. The mean dental plaque index was 1.37±0.53 in the total population of Shahrekord children (1.23±0.49 in girls and 1.54±0.55 in boys). Children spend most of their time studying and watching television and spend less time on calls and listening to music. There was no significant relationship between the mean score of overall sedentary entertainment and plaque index (p-value=0.092). However, there was a direct and significant relation between watching television and computer games with dental plaque index (p-value˂0.05). Increasing sedentary entertainment in children, such as watching television or playing computer games, may affect children’s oral health. Therefore, it is important for dentists to consider children’s lifestyle as an influencing factor in oral health.

This study aims to evaluate the role of Shear Wave Elastography (SWE) in the differentiation of malignant from benign cervical lymph nodes and compare its accuracy with conventional ultrasound.  Seventy-one lymph nodes (malignant=52, benign=19) were investigated by both conventional sonography and SWE. Shear Wave Velocity (SWV) and color map were obtained for each lymph node before tissue sampling. R statistical software (x64, v3.6.1) was used for statistical analysis. Among all the conventional and elastography features, color map grading and shear wave velocity (SWV) had the most correlation with malignancy, even in normal-sized nodes. SWV was significantly correlated with the pathology (rpb=0.62, p<0.00). The best cutoff-value for SWV was 2.71 m/s (sensitivity: 82.7%, specificity:84.2%, AUC=0.92). The best predicting model by multivariate analysis was obtained by a combination of SWV and color map grading (sensitivity=92.3%, specificity=94.7%).  SWE is a valuable method for the differentiation of malignant from benign lymph nodes. It would help to find the proper lymph node for biopsy.

Shoulder disorders are one of the most common problems in orthopedic patients. With the development of shoulder disease treatment methods and the invitation of new therapies, the need for a standard tool to assess shoulder function increases. One of these tools is a questionnaire that should have acceptable reliability and validity. Constant Score (CS) is one of the first shoulder scoring systems that has been used as the most common scoring system to assess shoulder disorders. This questionnaire was redeveloped in 2008 with a change in terms and methodology and is currently in use in many countries. Due to the lack of a Persian version, this questionnaire is used in inaccurate translation without any specific and standard instructions in Iran right now. As a result, this study provides a complete and standard translation of this questionnaire.

While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney. In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation.  Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate.  Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients.

Cardiovascular Diseases (CVD), mainly Hypertension (HTN), is the leading cause of death among women. Uterine Leiomyomas (UL) which have been associated with hypertension in multiple studies, may be a female-specific risk factor. Fibroids have become a primary reason for myomectomy and hysterectomy, nowadays. This study aims at the relationship between HTN and fibroids. This case-control study was conducted on patients with symptomatic UL, scheduled for surgery. Patients were studied based on Blood Pressure (BP), the number and size of fibroids, past medical conditions, and gynecological history. Four hundred patients, divided into two groups of control and case, were studied. Menometrorrhagia was the most common reason for referral in both groups (328 patients in general). The use of Oral Contraceptives (OCP) (12 vs. 5%), anemia (57 vs. 38.5%), history of infertility (11.5 vs. 3.5%), and abortion (38.5 vs. 22%) was significantly higher in patients with fibroids. 24% of patients with fibroid suffered from hypertension; which was higher in comparison to the control group (9%). Patients with UL were 4.9 times in danger of having HTN. UL is associated with hypertension. It is also concluded that anemia, rate of abortion, and infertility are higher in patients with UL.

Borderline Personality Disorder (BPD) is a serious psychiatric disorder that is characterized by unstable affect, mood, behavior, object relations, and self-image. In this study, a 6-month follow-up was performed to evaluate the outcomes of hospitalization in terms of symptoms severity, suicidal attempts, self-harm behaviors, substance use, and anger expression. This cross-sectional study was performed on 60 patients hospitalized with BPD in Iran Psychiatric Hospital in the first 6 months of 2018. Demographic information of patients was collected at the time of admission. Patients were assessed by initial psychiatric evaluations with the Structured Clinical Interview for DSM-IV [Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-2)], the Borderline Evaluation of Severity over Time (BEST), the Spielberger’s state-trait anger expression inventory and Depression Anxiety Stress Scale (DASS). Medical comorbidities, self-harm and suicide ideations and attempts, high-risk behaviors, and substance use disorders were also assessed and recorded. Three months after discharge, the patients were reassessed by BEST questionnaire and after 6 months, they were reassessed using DASS, BEST, SCID-2, and Spielberger’s state-trait anger expression inventory.  The repeated measures analysis of changes in quantitative variables including the scores of the severity of symptoms in BEST, DASS, and Spielberger tools showed that the scores of DASS decreased significantly during the study (p=0.020), while no significant change was observed in the scores of Spielberger and BEST inventory. In patients with BPD, hospitalization was correlated with reduced depression, anxiety, and stress 6 months after discharge. Regular follow-ups along with regular patient visits can form an effective therapeutic relationship with the patients and help to improve monitoring of their drug usage, self-harming acts, and suicidal thoughts.

This study was planned to compare Trans - epithelial Photorefractive Keratectomy (TPRK) and Alcohol Assisted Photorefractive Keratectomy (AAPRK) laser vision correction in hyperopia and compound hyperopic astigmatism. This quasi-experimental study was conducted on patients with hyperopia and hyperopic-astigmatism, whose eye laterality was randomly assigned to undergo TPRK versus AAPRK using SCHWIND AMARIS 1050RS (SCHWIND eye-tech-solutions, Germany). Follow up time was 1, 3, 6 and 12 months after surgery. 112 eyes of 56 patients with mean age of 32.6 years included, of which 51.8% were female and 48.2% were male. Both TPRK and AAPRK methods were able to correct hyperopia and astigmatism safely and efficiently (p<0.05 in all cases). Postoperative vision characteristics were similar in both methods (p=0.23 for sphere, p=0.52 for cylinder, p=0.064 for axis, and p=0.35 for BCVA) postoperatively. Corneal haze was observed in 44% of the patients with a direct strong correlation with hyperopia severity (r=0.607). Post-operative pain was observed in 60% of the patients with a direct weak correlation with hyperopia severity (r=0.27). Mild photophobia was seen in 42% of the patients with a direct weak correlation between photophobia and hyperopia severity (r=0.36). Epithelial healing time lasted an average of 3.48 days and there was a direct and moderate correlation with hyperopia severity (r=0.4). Safety index in TPRK and AAPRK was 0.54 and 0.45, respectively, with no significant difference (p=0.42); Efficacy index was 0.96 and 0.9 in TPRK and AAPRK, respectively and there was no significant difference between two groups (p=0.23). No complication was observed in all of the patients. TPRK and AAPRK laser vision correction are both safe and efficient in hyperopia and compound hyperopic astigmatism. There is no significant difference regarding epithelial healing time, post-operative pain and haze formation between two procedures.

This study aimed to assess the effect of internal bleaching on the microshear bond strength of composite resin to dentin in recently restored teeth. This in vitro, experimental study evaluated 40 sound human premolars. The teeth were sectioned below their cementoenamel junction. Access cavity was prepared, pulpal tissue was removed and filled with glass ionomer. The teeth were then randomly divided into 4 groups. In the control group, no internal bleaching was performed and dentin surface was restored with composite. In group 2, internal bleaching with 35% hydrogen peroxide (Opalescence, ultradent) was performed 4 weeks after composite restoration. Bleaching was performed immediately after restoration of teeth in groups 3 and 4. Teeth were etched with 35% phosphoric acid for 15 seconds, rinsed, dried, and primer and adhesive (Adper Scotchbond Multipurpose) were applied. The teeth were then restored with Z250 (3M ESPE) microhybrid resin composite. Teeth were sectioned into 1 mm2 sections and underwent micro-shear bond strength test. In groups 1 to 3, bond strength was measured after 24 hours while in group 4, it was measured after 1 month. Data were analyzed using one-way ANOVA.  The mean micro-shear bond strength of composite to dentin was maximum in group 2 and minimum in group 3. However, the difference in this respect was not significant among the groups (p>0.05). In teeth requiring immediate esthetic restorations, treatments can be performed after non-vital bleaching with no time restriction and adequately high bond strength comparable to non-bleached teeth.

Sexual Dysfunctions (SDs) and High-Risk Sexual Behaviors (HRSBs) are highly prevalent and substantial issues among patients with severe psychiatric disorders. However, studies exploring them are still infrequent. This study was conducted to evaluate SDs and HRSBs in women with severe psychiatric disorders. 

Female inpatients and outpatients of the Iran Psychiatry Hospital were selected if they were 18-60 years old, able to read, and diagnosed with schizophrenia, schizoaffective disorder, or type one Bipolar Disorder (B1D). After the initial interviews, the outcomes were assessed using the Female Sexual Function Index (FSFI), Youth Risk Behavior Surveillance System (YRBSS), and Sexual Risk Survey (SRS) questionnaires.

The mean (standard deviation) age of the 159 patients was 36.9 (10.1). B1D, schizophrenia, and schizoaffective disorder were diagnosed in 98, 53, and eight patients, respectively. FSFI evaluations demonstrated that several SDs, including pain and decreased sexual desire, are highly prevalent in them. Based on the results of YRBSS and SRS evaluations, the most predominant HRSBs were sexual behaviors without leading to complete intercourse, having sex without a barrier or effective contraception, using alcohol and drugs before sex, and impulsive sexual intercourse with inadequately known partners. 

All evaluated SDs had a high prevalence attributable to the pathophysiology of severe psychiatric disorders and related medications. HRSBs were also widespread due to impaired judgment, poor knowledge, or sexual characteristics of the disorders. These results support the need for further educating these patients concerning safe sexual behaviors and interactions of contraceptive medications with specific psychiatric medicines, including carbamazepine and sodium valproate.

The present study was conducted to investigate the effect of tea tree oil on Dry Eye Syndrome (DES) after Photorefractive Keratectomy (PRK) laser surgery. This retrospective historical cohort study was conducted on 64 patients with complaints of DES after PRK surgery. The patients were classified as and assessed in two groups: (1) tea tree oil group who used antibiotic, steroid drop and tea tree oil shampoo, and (2) artificial tear group with antibiotic, steroid and artificial tear drops usage. The data of the study was obtained by the Ocular Surface Disease Index (OSDI) and the Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED) questionnaires’ scores on two occasions, one and three months after surgery in follow-up visits. Additionally, refraction, corrected distance visual acuity, Schirmer’s and tear break-up time tests were recorded. The patients’ mean age was 35.12±13.97 (range: 18-70 years), of whom 38 (59.4%) were female and 26 (40.6%) were male. The average score of the dry eye calculated from OSDI and SPEED questionnaires in patients treated with tea tree oil shampoo was significantly reduced compared with patients treated with artificial tear drop in three months after surgery (AR=0.136 and p<0.05). Furthermore, tear break-up time significantly increased in patients, indicating the improvement of DES. Schirmer’s test and corneal staining with fluorescein did not improve significantly (p<0.05). The use of tea tree oil shampoo can improve dry eye syndrome after photorefractive keratectomy laser surgery.

Middle molecules, including some cytokines such as IL-6 and TNF-α, parathyroid hormone, etc., are types of uremic toxins having roles in the development of inflammation in hemodialysis patients. Different studies evaluating effects of coenzyme Q10 (CoQ10) on different inflammation markers in hemodialysis patients have controversial results. Moreover, no study determined the effect of CoQ10 on plasma concentration of IL-6, the most powerful predictor of poor outcomes and mortality, in hemodialysis patients. Therefore, a study was designed to examine the effects of CoQ10 supplementation on IL-6, TNF-α, and intact parathyroid hormone (iPTH) in chronic hemodialysis patients. In this single-blind randomized controlled trial, patients undergoing hemodialysis were randomly assigned to CoQ10 (100 mg/day) or control group. The duration of the study was 12 weeks. The plasma concentrations of IL-6, as the primary outcome, and TNF-α and iPTH, as the secondary outcomes, were measured at baseline and week 12.  Of 73 enrolled patients, 68 completed the study. At the end of the study, there were no significant differences in the concentrations of IL-6 (p=0.570), TNF-α (p=0.301), and iPTH (p=0.642) between the two groups. The standardized mean difference (CoQ10 vs. control) was -0.13 (95% CI -0.60; 0.35) for IL-6, -0.25 (95% CI -0.73; 0.22) for TNF-α, and 0.11 (95% CI -0.36; 0.59) for iPTH.  This study showed a trivial effect of CoQ10 supplemen-tation on the concentrations of IL-6 and iPTH and a small effect on the level of TNF-α in hemodialysis patients.

The coronavirus (COVID-19) pneumonia has been spreading worldwide since February 2019.  The most common symptoms are fever, dry cough and fatigue. The virus may affect the lungs, leading to complete opacification and in some cases death. Numerous attempts have been made in early diagnosis through imaging and laboratory tests. Imaging examinations such as conventional x-ray chest radiography and Multi-Detector Computed Tomography (MDCT) are now being used for assessment of the lungs. The authors have presented a case in which signs of COVID-19 were detected in cancer patient undergoing Radiotherapy (RT) using Cone Beam Computed Tomography (CBCT). Cone Beam Computed Tomography is a safe, low dose, three dimensional lung screening evaluation method, in patients suspected for chronic and acute pulmonary diseases and COVID-19.

Superficial Venous Aneurysm (SVA) are rare venous diseases that may be asymptomatic or symptomatic. The major etiology of SVA is still unknown. The study presents 17 cases with no underlying disease or risk factors that presented SVA in uncommon and different veins of the body.

17 patients with SVA were evaluated and treated in our hospital for 11 years. Clinical presentation, treatment, and complications were evaluated.

6 of the aneurysms were located in the great saphenous vein, 2 in the small saphenous vein, 6 in the external jugular vein, 1 in the dorsal foot vein, and also 2 in the forearm veins. Ten patients suffered from acute tenderness, pain, and edema of the limb and others presented with soft tissue mass. All 17 patients underwent surgical excisional therapy. No pulmonary emboli were reported in the patients. 

The etiology of SVA is unknown. It may cause occlusion in rare superficial veins in patients with no history of the hyper-coagulopathy state or any major risk factor.