left paraduodenal hernia causing bowel obstruction: a case report

A 41-year old mentally retarded patient presented acutely with a 3 day history of vomiting and absolute constipation. Intestinal obstruction was diagnosed following an abdominal x ray. At laparotomy, a left paraduodenal hernia was present, without incarceration of small bowel. The herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed

Peutz-Jeghers syndrome without mucocutaneous pigmentation: a case report

Peutz-Jeghers syndrome is a rare condition characterized by mucocutaneous pigmentation, polyposis and an increased cancer risk at a number of gastrointestinal and extra intestinal organs. We present a patient with a history of gastrointestinal bleeding with no mucocutaneous pigmentation. Upper and lower gastrointestinal endoscopy revealed multiple polyps located in the deuodenum and colon. Histopathological evaluation of the polyps revealed hamartomatous polyps of Peutz-Jeghers syndrome

Endovascular repair of traumatic pseudoaneurysm of the descending thoracic aorta: report of three cases and review of articles

Traumatic descending thoracic aorta pseudo aneurysms have been treated traditionally with open surgery in the past, which have had noticeable rates of mortality and morbidity. A safer method of treatment for this disease is made possible with recent progress in endovascular treatment techniques. In this article, we present three cases of Traumatic descending thoracic aorta pseudo aneurysms that were treated with Thoracic endovascular aortic repair [TEVAR] and discharged from our clinic without any complication

[ effects of hemovac on short- term outcome of Lichtenstein herniorrhaphy]

Many patients with inguinal hernia are operated and hemovac is used to drain extra fluids from the surgery site. In this study, we compared the results of surgery in patients operated with hemovac vs. who had not hemovac. In a randomized clinical trial, 86 patients with inguinal hernia were assigned into two groups. Patients were operated by Lichtenstein method and hemovac was used in one group. The short- term outcome was compared between two groups. Severity of pain in hemovac group was mild in 20 cases, moderate in 16 and severe in 5, and in non hemovac group was mild in 19 cases, moderate in 20 and severe in 2. Severity of scar in hemovac group was mild in 21 cases, moderate in 20 and severe in 2, and in non hemovac group was mild in 25 cases, moderate in 16 and severe in 2. Inflammation in hemovac group was mild in 23, moderate in 20 and nobody had severe inflammation, while in non hemovac group was mild in 31 cases, moderate in 11 and severe in 1. There were no significant differences in pain, scar and inflammation among groups with and without hemovac. Using hemovac in inguinal hernia repair does not have effect on the healing of surgery site

Thymectomy after plasmapheresis in myasthenia gravis: results of long term follow up

Myasthenia gravis is the most common disorder of neuromuscular junction and several treatment modalities have been described for its management. Thymectomy has been employed as a treatment modality for several years. Plasmapheresis has also been supposed as an adjunct to thymectomy in several articles. In this study, we describe long-term results of thymectomy after plasmapheresis in myasthenic patients operated on in Shohada-e-Tajrish medical center from March 1996 to March 2001. Information related to patients was obtained from medical records. All 46 patients underwent plasmapheresis before thymectomy and were transferred to ICU [intensive care unit] postoperatively. The surgical approach in all patients was median sternotomy and complete removal of thymus gland. Long term results of surgery were obtained via calling the patients. By this manner 31 of 46 patients were followed up. Forty-six patients including 36 women [78.3%] and 10 men [21.7%] with the mean age of 25.6 +/- 11.8 years were operated on in this period of time. The mean duration of symptoms was 15.7 months before the surgery. No postoperative mortality was seen. Five patients [10.9%] developed postoperative myasthenic crisis which was minimal in 4 of them. The mean duration of ICU stay was 18.9 hours. Thirtyone of 46 patients were followed up with a mean duration of 7. 7 years. Twelve patients [38.7%] had complete remission without using any drug. Twelve patients [38.7%] had significant improvement via decreasing the drug dosage necessary to control their symptoms. Two patients [6.4%] had no change in their disease status after the operation and in 1 patient [3.2%] with thymic pathology of invasive thymoma, the disease worsened. Four patients [12.9%] had disease recurrence after a period of complete remission. Result of operation was more satisfactory in patients younger than 30 years [p < 0.05%]. Thymic hyperplasia foresees more favorable outcome compared to other thymic pathologies. The mean duration of time necessary to reach final results was 19.6 months. As a result of this study, thymectomy seems to be a successful treatment modality in myasthenic patients and should be performed as soon as possible during the disease course. Besides, plasmapheresis has a significant role in decreasing the complications and improving the results of thymectomy in myasthenic patients and long term follow up is necessary for accurate evaluation of final results of operation