Iatrogenic seeding of tumor cells in thigh soft tissue upon surgical removal of intracranial meningioma

Introduction: Meningioma is a benign and slowly-growing tumor that is responsible for 20% of brain neoplasms. It can be accompanied by some genetic disorders such as neurofibromatosis type 2 and is more common among women. As a space occupying lesion, it produces a wide range of signs and symptoms by compressing the adjacent and underlying tissues in the brain. Trauma and viruses are possible etiologies for meningioma. The ideal treatment of benign meningioma is surgical resection

Case Presentation: In this case report, we present a middle-aged man with a seeding metastasis of the cranial meningioma [after its removal] in the left thigh. During the removal operation, fascia lata had been used to repair the dura mater and the skin defect was repaired primarily

Conclusion: We believe that the occurrence of meningioma at the site of incision in the thigh is related to using the same surgical instruments for the removal of the brain tumor

Management of sigmoid volvulus: options and prognosis

To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. A case series. Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008. A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software [version 18] was used for the data analysis. In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 [36.87%] cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 [63.13%] patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 [29.1%], Mikulicz procedure in 9 [6.6%], laparotomy detorsion in 37 [27.01%], Hartmann procedure in 47 [34.3%], mesosigmoidoplasty in 3 [2.19%] patients and total colectomy in one [0.73%] case. The overall mortality was 9.8% [22] patients. In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement

Temporary abdominal closure in the critically ill patients with an open abdomen

The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags [Bogot? bag]. The study population comprised of 11 [57.9%] male and 8 [42.1%] female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 [57.9%] patients, subjective judgment that the fascia closure is too tight in 6 [31.6%] patient's damage control surgery in one patient [5.3%] and development of abdominal compartment surgery in one patient [5.3%]. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 [47.4%] patients, post operative intestinal fistula in 4 [21.1%] patients, post traumatic intra abdominal bleeding in 3 [15.8%] patients and intestinal obstructions in 3 [15.8%] patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 [%21.1] early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 [26.3%] late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 [range 2-54] months. Currently 10 patients [52.6%] are alive at a follow up of 45 [range 1-94] months. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogot? bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage

[Primary paravertebral hydatid cyst: a case report]

Eating the egg of Echinococcus granulosus tapeworm in vegetables contaminated with dog's fecal material is the main cause of hydatid cyst. The most common involved organ is liver and the second are lungs. Spinal involvement especially primary involvement of paravertebral soft tissue without vertebral and extradural involvement is very rare. We report a case with paravertebral hydatid cyst without vertebral involvement. A 61 years old man patient resident of Torbatjam, Khorasan Razavi provience, was admitted to our department complaining a mass in back from six years ago. In physical examination he had several right paravertebral masses. MRI reveals a huge multilocular mass in the right paraspinal from T1 to L5 that is accompanied by ribs erosion without destruction. Operation was performed and the cyst was completely removed while contained several liquid-filled cysts, the hydatid-like cysts. Pathological findings were confirmed the diagnosis. Albendazole [10mg/kg] was prescribed postoperatively for six months. Recurrence has not occurred after two years follow up. Hydatid disease is a major infectious disease that is a main problem in many countries. In some articles paravertebral involvement without vertebral and extradural involvement is reported but primary paravertebral involvement with hydatid cyst is very rare. In this case we report paravertebral without vertebral involvement and the patient did not show any sign of spinal and vertebral pressure. In spite of the fact that hydatid cyst involves liver and lungs more than other organs, it can involve any organ and this point should be taken into consideration especially in the endemic areas.

[Pelvic hydatid cyst with uncommon sciatalgia manifestation: a case report]

Hydatid disease or echinococcosis is a common parasitic disease of human and bovine, caused by infection with larva of the cestode echinococcus. Liver is the most common organ that is involved in this disease. Pelvic involvement and neurological symptoms, due to mass effect of pelvic involvement, in lower extremities are very uncommon manifestations of the disease. A forty six year old man was referred to clinic of surgery at Ghaem Hospital, Medical University of Mashhad, Iran. The patient complained about weakness and motor impairment in right lower extremity accompanied by numbness and radicular pain over past two months. Physical examination demonstrated muscular atrophy and reduced muscular strength in right lower extremity. Computed tomography and ultrasonographic studies showed a cystic mass in right side of the pelvic cavity with extention to the sciatic notch and another cystic mass in right gluteal region. Surgical operation revealed a cystic mass deep in pelvic cavity with the extention to the right sciatic notch with compression of nerve roots. The cystic mass was contained of daughter cysts which confirmed the diagnosis of hydatid cyst disease. This diagnosis was confirmed by pathologic assessment. Although uncommon, but hydatid disease can involve the pelvic cavity and make a pelvic, usually cystic, mass; that can make compression on nerve roots and so making neurologic symptoms in lower extremities. So in endemic areas for hydatid disease, such as Iran, pelvic hydatid cysts should be considered as a possible differential diagnosis in patients presenting with the sciatic pain and neurological manifestations in whom a pelvic mass has been found too.

Thoracoscopic splanchnicectomy for pain control in unresectable pancreatic cancer

Severe pain is a major problem in patients with unresectable pancreatic cancer. The goal of this study is to evaluate the effects of Thoracoscopic Splanchnicectomy [TS] on pain control in these patients suffering from unresectable pancreatic cancer Between years 2000 to 2011, 20 patients suffering from unresectable pancreatic cancer underwent TS due to severe pain. They were studied in terms of age, sex, location of pancreas tumor, history of previous surgery, response to treatments for pain control [assessed with VAS scoring system] and complications of surgery Male to female ratio was 14/6 with a mean age of 63 years. The most common tumor site was at the pancreas head [in 8 patients]. The most cause of unresectability was local expansion to critical adjacent elements [in 10 patients]. Surgery was performed successfully in all patients. Postoperative complication included only pleural effusion on the left side which was cured by proper treatment. There were no post-op mortalities. Fifteen patients had acceptable levels of pain at the end of a six month follow-up period TS provides good pain control, little side effects and minimal invasiveness, the technique is recommended for pain control in patients with unresectable pancreatic cancer

[Adult choledochal cysts in 23 patients: a brief report]

Choledochal cyst is a congenital disease of hepatobiliary system. Patients with the disease differ in terms of gender and symptoms. In this study, we aimed to evaluate the patients from clinical signs and symptoms, diagnostic methods and treatment perspectives. In this retrospective study, we evaluated the data from the medical records of patients with choledochal cyst admitted in Ghaem and Omid hospitals affiliated to Mashhad University of Medical Sciences in Mashhad, Iran during 1994 to 2011. The medical records of 23 [18 women and 5 men] patients were evaluated. The mean age of the patients was 24.6 years. The most common type of the disease was choledochal cyst type 1. The most common type of surgery performed in the patients, respectively was resection of biliary cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. No mortality was observed during the hospital stay or follow-up period. Surgical complications were minor and patients recovered by conservative measures. Regarding the favorable results of surgical treatment of choledochal cysts, timely and definite diagnosis of this congenital anomaly and proper planning for its surgery are of special importance.

Illness perception of breast cancer in affected women undergoing chemotherapy

The aim of this study was to investigate the various aspects of illness perceptions about breast cancer in affected patients. A cross-sectional study enrolled 140 patients with breast cancer in their chemotherapy period within 14 months. The revised Illness Perception Questionnaire [revised IPQ] was used to assess the disease representations of breast cancer. The data were analyzed by SPSS v.18 software. The mean age of participants was 49.3 +/- 10.3 years. There was no significant correlation among the various items of illness perception of breast cancer in the affected patients with the demographic and clinicopathologic stages of the disease [P>0.05]. The present study explored breast cancer to identity component 2.1[less symptoms attributed to cancer], timeline component 2.86 [encountered to a acute illness], treatment control 3.21 [less therapeutic belief], illness coherence 3.29 [less knowledge about cancer], serious consequences 2.79 [not attributing too much grave results], personal control 3.43 [illness controllable by the personal measures] and emotional representations 2.90 [emotionally good]. Also most of our patients attributed stress as the cause of breast cancer [93.6%].The internal consistency of revised IPQ was 0.84 [Cronbach alpha]. The patients affected with breast cancer perceived their illness to be short with better personal controllability. They had optimistic views towards the personal, familial and social implications of their illness. Also our patients showed less distress, anger and disappointment while being less optimistic about the treatment modalities and less coherent about their illness