Rare presentation of retroperitoneal schwannoma: a case report

The deadly Schwannomas, as uncommon subtype of soft tissue tumors originate from peripheral nerve sheaths. Retro peritoneum is an uncommon site for these tumors. Here we present the clinical feature and therapeutic implication of a 38-year-old man affected by recurrent retroperitoneal schwannoma who admitted to emergency ward following abdominal pain. Computed Tomorgraphic Scan showed a solid well-differentiated heterogeneous mass, 8.56 cm size in portahepatis beneath liver and right periumbilical. On laboratory tests Cancer Antigen 19-9 and Cancer Embryonic Antigen were in normal range. In surgery, a 78 cm round mass was discovered at juxta renal juxta duodenal retro peritoneum, It was completely adhered to second part of duodenum with no signs of infiltration of the liver and right kidney, unable to simply being enucleated, curative resection was performed by classical whipple procedure. The patient's hospitalization course was uneventful and on the second week he was discharged from the hospital with complete recovery. Due to the high recurrent rate of retroperitoneal Schwannomas even in benign circumstances, radical resection would be the treatment of choice

Familial adenoma to us polyposis: ileo-anal pouch versus ileo-rectal anastomosis

In this study we describe the presentation, treatment, and complications of 27 FAP patients. Treatment of Familial adenomatous polyposis [FAP] is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis [IPAA] or colectomy with ileo-rectal anastomosis [IRA]. All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure. Overall 27 patients were included, 12 [44.44%] index patients, and 15 [55.55%] relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect [70.37%], followed by bowel discomfort episodes [55.56%], requiring dietary restrictions [37.4%], passive incontinence [25.93%], soiling [22.22%], nighttime stool frequency [18.52%], flatus incontinence [16.0%], and anastomosis leakage [3.70%]. On average patients treated by IPAA experienced less complication than those treated by IRA. compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP

Neo-adjuvant chemoradiotherapy; an opportunity in sphincter preserving procedure for rectal cancer

Aim: The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery

Background: For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer

Patients and Methods: Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed

Results: 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 [55%] underwent APR while 15[32%] and 6[13%] patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 [53%] underwent APR while 14 [25%] and 10 [18%] patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference [p=0.0001]

Conclusion: Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors

Treatment of great saphenous vein insufficiency by endovenous laser therapy: clinical description and short term follow up of 20 Iranian patients

Endovenous Laser Therapy [EVLT] for Greater Saphenous vein [GSV] insufficiency is a newly established method of treatment only recently made available in Iran. The present study seeks to describe the results of the first 20 patients treated with EVLT at Shohada-e Tajrish Medical Center, Tehran, Iran. 20 patients [16 male, 4 female] with the mean age of 38.9 and an average length of symptoms of 5.9 years, were treated with a 980-nm laser diode under local anesthesia. CEAP classification [Clinical Severity, Etiology, Anatomy, Pathophysiology] and AVSS scores [Aberdeen Varicose Vein Symptom Severity Score] were used to determine disease severity and symptoms before and after the procedure. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation. The mean procedure time was 49 minutes, and the mean admission time was 1.1 days. A success rate of 85% percent was recorded at 6-12 months of follow up. The patients showed a significant reduction in AVSS and CEAP scores [PV=0.0001], Pain [PV=0.00001], Parasthesia and Edema [PV=0.001]. EVLT seems promising as a novel method of treatment for GSV insufficiency in the Iranian population with many advantages, including higher success rates in comparison with conventional methods of treatment

Infections after laparoscopic and open cholecystectomy: ceftriaxone versus placebo; a double blind randomized clinical trial

Gallstone disease is one of the most common gastrointestinal diseases requiring surgery with probable postoperative infection. The role of prophylactic antibiotics [AB] in prevention of infection is controversial. This study aimed to compare the manifestations, complications and outcomes of two groups of patients, those receiving prophylactic AB versus placebo, in order to determine whether antibiotic therapy is required. In this double blind randomized clinical trial, we studied 130 patients with symptomatic cholelithiasis or polyps of gallbladder admitted in Shohada-e-Tajrish Hospital, Tehran, Iran for cholecystectomy between 2006 and 2008. Patients were randomly assigned in two subgroups: the first group received Igr ceftriaxone during induction of anesthesia and the second group received l0mL of isotonic sodium chlorides solution as placebo. All patients were followed for 4 weeks after surgery. The study population included 61 males and 69 females with the mean age of 49.3 +/- 9.6 and 51.8 +/- 9.9 years in treatment and placebo group, respectively. Of 130 bile culture results, 83 were negative. Escherichia coli, Klebsiella and Staphylococcus aureus were the most common cultured bacteria. There was no statistically significant difference in culture results between the patients received AB and placebo [MS]. The surgical technique [open versus laparoscopic] did not influence the culture results. It can be concluded that prophylactic antibiotics do not have any preventive effect on wound infection in a double blind setting. According to our findings, routine antibiotic prophylaxis as recommended for biliary surgery [open or laparoscopic cholecystectomy] is now questionable