A complicated case of primary aortojejunal fistula: A case report.

BACKGROUND: Aortoenteric fistulas are rare and life-threatening pathology characterized by an abnormal connection between the aorta and the gastrointestinal tract. CASE PRESENTATION: The patient is a 61-year-old male who initially presented with hypogastric pain, hematemesis, and melena. Computed tomography angiography (CTA) revealed an abdominal aorta aneurysm but not a fistula. Imaging modalities were inconclusive in the diagnosis. The patient became unstable hemodynamically and was transferred to the operation room. The definitive diagnosis of aortoenteric fistula was confirmed during surgical exploration. Urgent surgery was performed; however, the patient experienced a cascade of complications, including rebleeding, intestinal leakage, and hemodynamic instability due to aortic bleeding. Despite rigorous interventions, the patient expired due to multiple organ failure 53 days after the first repair surgery. CLINICAL DISCUSSION: There is no definite imaging method due to the lack of guidelines, and the absence of exact findings has led to intraoperative diagnosis in up to 50 % of cases. This is one of the modalities of choice to examine suspected aortoenteric fistulas. Many authors prefer Computed tomography (CT) with intravenous contrast for suspected AEF despite its limitations in clarity. Others recommend CT angiography as the preferred modality. It is worth noting that, as reported in a comprehensive retrospective review, the mortality rate is approximately 46 % within 60 days after AEF repair surgery. CONCLUSION: This report adds to the limited data about primary aortojejunal fistulas, an extremely rare type of aortoenteric fistulas which has been reported in only a few cases. Understanding the importance of promptly suspecting, diagnosing, and intervening is crucial, emphasizing the importance of sharing such cases for medical guidance and better patient outcomes.

Moving beyond nanotechnology to uncover a glimmer of hope in diabetes medicine: Effective nanoparticle-based therapeutic strategies for the management and treatment of diabetic foot ulcers.

Hyperglycemia, a distinguishing feature of diabetes mellitus that might cause a diabetic foot ulcer (DFU), is an endocrine disorder that affects an extremely high percentage of people. Having a comprehensive understanding of the molecular mechanisms underlying the pathophysiology of diabetic wound healing can help researchers and developers design effective therapeutic strategies to treat the wound healing process in diabetes patients. Using nanoscaffolds and nanotherapeutics with dimensions ranging from 1 to 100 nm represents a state-of-the-art and viable therapeutic strategy for accelerating the wound healing process in diabetic patients, particularly those with DFU. Nanoparticles can interact with biological constituents and infiltrate wound sites owing to their reduced diameter and enhanced surface area. Furthermore, it is noteworthy that they promote the processes of vascularization, cellular proliferation, cell signaling, cell-to-cell interactions, and the formation of biomolecules that are essential for effective wound healing. Nanomaterials possess the ability to effectively transport and deliver various pharmacological agents, such as nucleic acids, growth factors, antioxidants, and antibiotics, to specific tissues, where they can be continuously released and affect the wound healing process in DFU. The present article elucidates the ongoing endeavors in the field of nanoparticle-mediated therapies for the management of DFU.

Traumatic arteriovenous fistula mimicking cutaneous leishmaniasis: A case report.

INTRODUCTION: Traumatic arteriovenous fistula (TAVF) may be challenging to diagnose and can be misjudged as skin lesions or ulcers, including cutaneous leishmaniasis. Here, we present a patient with TAVF misdiagnosed and treated as cutaneous leishmaniasis. CASE PRESENTATION: A 36-year-old male presented with a non-healing venous ulcer in his left leg, which was misdiagnosed and treated as cutaneous leishmaniasis. He was referred to our clinic, where color Doppler sonography showed arterial flow in the left great saphenous vein, and Computed tomographic (CT) angiography revealed left superficial femoral artery fistula to the femoral vein. The patient had a history of shotgun injury six years ago. Surgical closure of the fistula was done. The ulcer healed completely one month after the surgery. DISCUSSION AND CONCLUSION: TAVF may present as skin lesions or ulcers. Our report emphasizes the importance of thorough physical examination and history taking and the use of color Doppler sonography in order to avoid unnecessary diagnostic and therapeutic modalities.

Ruptured innominate artery pseudoaneurysm presenting as hoarseness in Behçet's syndrome: a case report.

BACKGROUND: Vascular involvement is an infrequent clinical manifestation of Behçet's syndrome. Owing to the rarity of arterial involvement in Behçet's syndrome, there is limited experience in managing this phenomenon. CASE PRESENTATION: Here, we report a 28-year-old Iranian man with a Behçet's syndrome background, who presented with shoulder pain and hoarseness. Chest computed tomography angiography was conducted with a suspicion of a vascular pathology causing pressure on the recurrent laryngeal nerves. The patient was diagnosed with a ruptured innominate artery pseudoaneurysm. An innominate artery to the right common carotid artery bypass was performed, and the pseudoaneurysm was excised and replaced with an expandable polytetrafluoroethylene graft. Eventually, the patient was discharged after an uneventful hospital course. CONCLUSION: It appears that we are still a long way from finding the optimal treatment for Behçet's syndrome vascular involvement, and a combination of surgical and medicinal treatments is required.

Association of Large Vessel Aneurysm/Pseudo-Aneurysm/Aortitis and Deep Vein Thrombosis in Patients with Behçet's Disease: A Case Report.

BACKGROUND: Behçet's disease (BD) is a complex vasculitis with some vascular manifestations including venous thrombosis, arterial thrombosis/aneurysm/pseudoaneurysm, and co-associated venous thrombosis and arterial lesions. We present two patients with Behçet's disease came with progressive both arterial and venous involvement. CASE PRESENTATION: The first patient was a young man with recurrent oral aphthosis and skin folliculitis and referred with complaint of new abdominal pain and 2 months severe headache. He had not referred to a physician due to COVID-19 pandemic until that time. In addition, he gradually developed a lower extremity edema and eventually was diagnosed with BD complicated with brain sagittal sinus vein thrombosis, abdominal aortic aneurysms and aortitis and deep vein thrombosis (DVT) of femoral vein. The second patient was a young woman with previous history of uveitis, DVT and recurrent oral and genital aphthosis presented with a large inguinal mass due to large iliac artery pseudoaneurysm impending to rupture, and after the operation, due to poor follow-up, developed a new femoral DVT. CONCLUSION: It seems the same inflammatory process is responsible for arterial and venous involvement in patients with BD, so it should be considered that involvement in one side (venous/arterial) can be a risk factor for the other side (venous/arterial) and early immunosuppressive treatment should always be considered to improve the prognosis.

Profunda Brachii Pseudoaneurysm following Supracondylar Fracture of Humerus Repair in an 8-Year-Old Boy: A Case Report and Review of Literature.

Arterial pseudoaneurysm can manifest in almost all arteries, but peripheral ones such as brachial artery pseudoaneurysm are rare and typically happen after trauma or infections. We describe an 8-year-old boy who presented with a large nonpulsatile soft tissue mass-like lesion 20 days after supracondylar fracture of the humerus which was fixed using Kirschner wire. The neurovascular examination was normal; CT angiography revealed a large pseudoaneurysm arising from the left profunda brachii artery. The patient went under surgical repair and was discharged from the hospital with an uneventful postop course. A high index of suspicion is necessary in cases with humeral fractures for the early diagnosis of pseudoaneurysm where the delayed diagnosis may cause fatal outcomes.

Inferior Vena Cava Repair Using Diaphragm in Animal Model.

BACKGROUND: Repair and reconstruction of the vena cava with an autologous vein requires multiple incisions. Prosthetic material is linked with an increased risk of infection and thrombosis. Therefore in this study, we created an animal model of vena cava repair using the diaphragm. The objective of this study is to assess the feasibility and outcomes of using diaphragm for the repair and replacement of the inferior vena cava (IVC) after resection of a part of the infrarenal IVC in an animal model, as it may be encountered in trauma patients and extensive tumors of retroperitoneum. METHODS: Five healthy dogs of both sexes were prepared. After general anesthesia and laparotomy, a 1 cm width with 4 cm length defect was arranged on anterior aspect of the infrarenal IVC, subsequently, the anterior aspect of the right diaphragm with 1 cm width and 4 cm length was resected and was anastomosed to cover the defect of the IVC as a patch graft, with the pleural side of the diaphragm facing the luminal aspect and the peritoneal side on the outside. The observation period was 6 weeks. RESULTS: All of the IVCs were macroscopically patent without thrombosis and stenosis. Pathologic assay revealed complete endothelialization of diaphragm. One dog died at the third night of operation without distinct reason. CONCLUSIONS: The diaphragm is an accessible and safe option in the repair and reconstruction of IVC particularly when restrictions exist for the use of prosthetic material in a contaminated space of the abdomen.

Hypothenar Hammer Syndrome: Surgical Approach in Patients Presenting with Ulnar Artery Aneurysm.

Hypothenar hammer syndrome is an uncommon condition but of high clinical importance due to ischemia-related complications. In this article, we discuss about our surgical approach to deal with hypothenar hammer syndrome patients suffering from ulnar artery aneurysm, which is surgical exploration and end-to-end anastomosis of the ulnar artery.

Using Amniotic Membrane as a Novel Method to Reduce Post-burn Hypertrophic Scar Formation: A Prospective Follow-up Study.

BACKGROUND: Several studies have shown that the application of amniotic membrane as a biological dressing in the management of burns is accompanied by rapid re-epithelialisation. In this follow-up study, we aimed to evaluate the possible role of amniotic membrane as an adjunct to split thickness skin grafting on reducing itching and severity of hypertrophic scar formation. MATERIALS AND METHODS: From October 2013 to January 2015, in a prospective follow-up study, 54 patients (108 limbs) with second and third degree burns, covering 4%-15% of total body surface area (TBSA), were included in the study. All patients needed split-thickness skin grafts for burn-wound coverage. Selected patients had symmetric burns on two (upper or lower) extremities. Then, in every patient, the extremities were randomly divided into two groups: In one limb, the skin graft was traditionally fixed with skin staples (control group) and in the other limb, the skin graft was covered with an amniotic membrane (amnion group). Therefore, in every patient, the graft was covered with an amniotic membrane in one extremity and fixed with skin staples in the other extremity. Finally, after 6 months, the degree of itching and hypertrophic scar formation was compared between the two groups. RESULTS: The study group was composed of 108 limbs in 54 patients (27 males and 27 females) with a mean age of 23.54 ± 4.9 years and burn 9.03 ± 2.69% TBSA. The patients were divided into two groups: 54 limbs in amnion group and 54 limbs in control group. In 59.25% of the cases, patient had less itching in the extremity covered with amniotic membrane. Furthermore, in 64.81% of the cases, patients had less hypertrophic scar formation in the extremity covered with amniotic membrane. These differences were statistically significant (P < 0.001). CONCLUSIONS: Amniotic membrane used as an adjunct in split thickness skin grafting is a novel modality which significantly reduces scar formation and itching that can be greatly distressing to burn patients. However, still more prospective well designed studies are needed to prove it.

Lymphaticoperitoneal and Lymphaticopleural Shunting to Treat Lymphedema; a New Therapeutic Approach.

Lymphedema is a common and progressive disease which causes deterioration of the quality of life of the patients, and still, there is no gold standard therapeutic option. In this article, we discuss about our new approach to deal with management of lymphedema which is lymphatic drainage by a subcutaneous channel which is designed as lymphaticoperitoneal and lymphaticopleural shunts for lower and upper extremity lymphedema, respectively.

Intestinal seromuscular tunneling: a novel method for ureteral replacement--an experimental design.

BACKGROUND: Long-segment ureteral injuries may have different etiologies. Although multiple procedures have been previously used for ureteral replacement, none of them had optimum results, and replacement of long segments of injured ureter is still a challenging surgical problem. In this article, we have hypothesized that it may be possible to use intestinal seromuscular tunneling as a novel method for ureteral replacement. METHODS: This experimental study was conducted on eight dogs. After cutting the ureter at about its mid-part and ligating the distal part, a 10-cm tunnel was made in the seromuscular layer of small intestine using a metallic probe, and a catheter was passed through it. Proximal and distal ends of the tunnel were anastomosed to proximal end of ureter and urinary bladder, respectively. After 8 weeks, the dogs were killed, and their whole urinary system was sent for histopathologic examinations. RESULTS: No complication was noted during the post-op period. Histopathologic examinations confirmed that the seromuscular tunnel was well patent, lined by pseudostratified transitional epithelium and without any inflammatory reaction. CONCLUSION: Our study shows that ureteral replacement by intestinal seromuscular tunneling is anatomically possible at least in animal model. However, more well-designed prospective studies are needed to confirm its long-term functional results.

Buerger's disease in the northeast of Iran: Epidemiology and clinical features.

BACKGROUND: The aim of this study is to present our long-term clinical experience in describing a clinical picture of Buerger's disease in our region. MATERIALS AND METHODS: In a retrospective study, files of 225 patients who were admitted to the hospital with diagnosis of thromboangiitis obliterans in a 10 year period from 2000 to 2010 were reviewed. All data including demographic, signs and symptoms, history of previous illness, history of smoking, medications, laboratory tests, angiography, and details of surgical operation were obtained. RESULTS: A total of 222 (98.7%) and 3 (1.3%) of patients were male and female, respectively. Average age of hospitalized patients was 40.7 ± 8.5 (20-62) years. A total of 200 patients (88.9%) were active cigarette smokers while 168 (74.7%) of them were opium addicts. The most prevalent symptoms were chronic ulcers (80%) and claudication (63.6%). Minor and major amputation was required in 113 (50.2%) and 41 (18.4%) patients, respectively. Amputation was carried out on the lower limb (80%), upper limb (4.1%), or on both (15.1%). Also, four patients underwent revascularization through surgical bypass procedures. CONCLUSIONS: The diagnosis and treatment of Buerger's Disease is still a challenge in those communities where the disease is endemic. Therefore, identifying the natural course of the disease can play a pivotal role in the diagnosis and treatment of these patients.

Low-level laser therapy: an experimental design for wound management: a case-controlled study in rabbit model.

BACKGROUND: There is a wide array of articles in medical literature for and against the laser effect on wound healing but without discrete effect determination or conclusion. This experimental study aims to evaluate the efficacy of low-level laser therapy on wound healing. MATERIALS AND METHODS: Thirty-four rabbits were randomly enrolled in two groups after creating a full thickness of 3 × 3 cm wound. The intervention group received low density laser exposure (4 J/cm(2)) on days 0, 3 and 6 with diode helium-neon low-intensity laser device (wl = 808 nm) and in control group moist wound dressing applied. Finally, wound-healing process was evaluated by both gross and pathological assessment. RESULTS: Fibrin formation was the same in the two groups (P = 0.4) but epithelialisation was much more in laser group (P = 0.02). Wound inflammation of the laser group was smaller than that of the control groups but statistical significance was not shown (P = 0.09). Although more smooth muscle actin was found in the wounds of the laser group but it was not statistically significant (P = 0.3). Wound diameter showed significant decrease in wound area in laser group (P = 0.003). CONCLUSION: According to our study, it seems that low-level laser therapy accelerates wound healing at least in some phases of healing process. So, we can conclude that our study also shows some hopes for low level laser therapy effect on wound healing at least in animal model.

Comparision of vacuum-asisted closure and moist wound dressing in the treatment of diabetic foot ulcers.

BACKGROUND: Vacuum-assisted closure (VAC) is a new method in wound care which speeds wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates. This study aims to evaluate its efficacy in the treatment of diabetic foot ulcers. MATERIALS AND METHODS: Thirteen patients with diabetic foot ulcers were enrolled in the moist dressing group, and 10 patients in the VAC group. The site, size and depth of the wound were inspected and recorded before and every three days during the study period. Patient satisfaction and formation of granulation tissue were also assessed. RESULTS: Improvement of the wound in the form of reducing the diameter and depth and increasing proliferation of granulation tissue was significant in most of the patients of the VAC group after two weeks. Satisfaction of patients in the VAC group was evaluated as excellent as no amputation was done in this group. Wagner score was reduced in both the study groups, although this decrement was not significant in the moist dressing group. CONCLUSION: VAC appears to be as safe as and more efficacious than moist dressing for the treatment of diabetic foot ulcers.