Surgical management of a rare giant ovarian serous cystadenoma with distinctive clinical manifestations.

Giant ovarian cysts are categorized with sizes >10 cm. After reaching huge diameters, these rare tumors cause clinical symptoms such as nausea, vomiting or abdominal pain. We present a 29-year-old woman with a giant unique cystadenoma represented with unusual clinical features like low back pain and progressive constipation. Specific imaging methods demonstrated an adnexal lesion in the form of an enormous ovarian cyst; afterward, an open laparotomy was recommended to access the abdominal cavity. The critical role of timely diagnosis and accurate workups for giant ovarian cysts in increasing patients' life expectancy and quality of life is discussed.

Comparison between Roux-en-Y gastrojejunostomy and Billroth-II with Braun anastomosis following partial gastrectomy: A randomized controlled trial.

Partial gastrectomy surgeries are conducted frequently due to various reasons but there is no consensus regarding the method of choice for gastrointestinal reconstruction. In this study we aimed to compare Billroth II with Braun anastomosis and Roux-en-Y gastrojejunostomy. This randomized, Single-blind clinical trial was conducted on patients presented to surgery clinic at Besat and Taleghani hospital between 2018 and 2020 who were gastrectomy candidates. Patients undergoing Billroth II reconstruction with Braun anastomosis or Roux-en-Y gastrojejunostomy were enrolled in the study. Demographics, operation durative and intraoperative blood loss, early postoperative complications, re-admission within 30 days post operation, 30-day and 90-day mortality were recorded. at an at least 3-month post-surgery period, patients were followed for late postoperative complications. If necessary, endoscopy was conducted and biopsy was taken. Analysis was performed with SPSS version 22. A total of 84 patients in two 42-patient groups were evaluated. All parameters were the same in two groups except operation duration and intraoperative bleeding (significantly higher in RY group), food residue (significantly higher in RY group) and bile in remnant stomach (significantly higher in B2B group). These two methods of reconstruction are comparable in terms of postoperative complications and mortality rates. Food residue and bile reflux are two determinants which should be kept in mind when choosing the surgery plan by surgeons. This trial was prospectively registered in the Iranian Registry of Clinical Trials with a registration ID of IRCT20130706013875N3.

Effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis: A randomised controlled trial.

This is a prospective randomized controlled trial to investigate the effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis. This study was a single-center randomized controlled trial performed at the general surgery ward of Taleghani hospital, in Tehran, Iran, from July 2018 to October 2018. Patients were randomly divided into two parallel groups, one receiving routine abdominal drainage and the other receiving no treatment. Postoperative pain was measured by the Universal Pain Assessment Tool (UPAT) 0, 2, 4, 6, 12, and 24 h postoperatively. A total of 60 patients (30 patients in the study and control groups) were included. GLM repeated measure analysis showed a significant time*treatment effect for routine abdominal drainage in decreasing UPAT scores from baseline to 24 h after surgery (F = 4.59, df = 3.98, P-value = 0.001). Our findings demonstrated that abdominal drainage significantly reduces postoperative pain 0, 2, 4, 6, and 12 h after surgery (P-value<0.05). We also showed that abdominal drainage increases the time to first morphine sulfate administration and decreases the total dose of morphine sulfate administration (P-value<0.001). Moreover, we demonstrated that abdominal drainage decreases the average postoperative pain (P-value<0.001) and does not lead to any considerable side effects. However, 24 h after surgery, no significant pain-relieving effect was evident for abdominal drainage. In conclusion, insertion of abdominal drainage leads to decreased postoperative pain. Future studies need to investigate the optimal time for removal of the abdominal drain. This trial was prospectively registered in the Iranian Registry of Clinical Trials with a registration ID of IRCT20130706013875N2.

Expression of miRNAs Targeting mTOR and S6K1 Genes of mTOR Signaling Pathway Including miR-96, miR-557, and miR-3182 in Triple-Negative Breast Cancer.

Triple-negative breast cancer (TNBC) is a highly aggressive form of breast cancer. Aberrant expression of genes in mTOR pathway and their targeting miRNAs plays an important role in TNBC. The aim of this study was to determine the expression of mTOR and S6K1 and their targeting miRNAs in breast cancer cell lines and clinical samples. miRNAs targeting 3'-UTR of mTOR and S6K1 mRNAs were predicted using bioinformatic algorithms. MDA-MB-231, MCF-7, and MCF-10A as well as 20 TNBC samples were analyzed for gene and miRNA expression using quantitative real-time PCR (RT-qPCR). A receiver operating characteristic (ROC) curve analysis was performed for evaluation of candidate miRNAs as diagnostic biomarkers. miR-96 and miR-557 targeting mTOR and S6K1 mRNAs, respectively, were selected, and miR-3182 was selected as the miRNA targeting both genes. The miRNAs were down-regulated in cell lines, while their target mRNAs were up-regulated. Similar findings were observed in clinical samples. The ROC curve analysis revealed decline in expression of these miRNAs. We suggest that miR-96, miR-557, and miR-3182 can be used as inhibitory agents for mTOR and S6K1 in TNBC-targeted therapy.

Promoter hypermethylation of RAR-ß tumor suppressor gene in gastric carcinoma: Association with histological type and clinical outcomes.

BACKGROUND: While gastric cancer is a common cancer in the world and Iran, its molecular mechanisms are not fully understood as yet. Epigenetic modifications can lead to alteration of gene expression and development of tumorigenesis mechanisms. METHODS: To clarify the difference in DNA methylation pattern of histological types in gastric carcinoma, CpG islands in the promoters of retinoic acid receptor ß gene (RAR-ß) was studied using methylation-specific PCR. RESULTS: In gastric cancer tissues, hypermethylation frequency of RAR-ß gene was respectively 61 and 33% for diffuse and intestinal type. In diffuse type, hypermethylation of RAR-ß has been significantly associated with invasion (P= 0.007), differentiation (P= 0.033) and location (P= 0.012) of the tumor. However, hypermethylation of RAR-ß correlated only with tumor size (P= 0.029) in intestinal type. For adjacent non-tumor samples, hypermethylation of RAR-ß was not detected and there was no significant association between age of diagnosis and hypermethylation of RAR-ß in both types of gastric cancer. CONCLUSIONS: These results support previous findings denoting a distinct profile of promoter hypermethylation status in the development of the intestinal and diffuse type of gastric carcinoma and the process of the tumorigenesis in these subtypes of gastric cancer is different from each other.

Over-expression of NOTCH1 as a biomarker for invasive breast ductal carcinoma.

Breast cancer is the leading cause of cancer-related death in women worldwide. Invasive ductal carcinoma (IDC) is the most frequent invasive form of breast cancer followed by metastasis. There is no accepted marker for distinguishing this form from other less aggressive forms of breast cancer. Therefore, finding new markers especially molecularly detectable ones are noteworthy. It has been shown that NOTCH1 has been overexpressed in the patients with breast cancer, but no study has investigated the expression of NOTCH1 and its correlation with other molecular and hormonal markers of breast cancer so far. In the current study, 20 breast cancer tissues and 20 matched adjacent normal breast tissue from breast cancer patients were obtained and categorized in two groups: patients with IDC and patient with other types of breast cancer. Gene expression analysis using real-time PCR showed that the NOTCH1 gene was significantly overexpressed in patients with IDC. We also found a slight correlation between NOTCH1 overexpression and p53 accumulation in the cancerous cells confirmed by Immunohistochemistry (IHC). This results showed that it is possible to introduce NOTCH1 expression as a novel biomarker of IDC, alone or preferably accompanied by IHC of p53. We also can design new therapeutic agents targeting NOTCH1 expression for inhibition of metastasis in ductal breast carcinoma.

Benign duodenocolic fistula as a complication of peptic ulcer disease.

A 44-year-old man with upper abdominal pain, diarrhea and 25 kg weight loss since 3 months ago was admitted. He had a history of dyspepsia and peptic ulcer disease 4 months before admission. Gastroduodenal endoscopy and upper gastrointestinal series with barium study were done. Biopsies and CT-scan ruled out malignancies. Endoscopy and radiology studies revealed a duodenocolic fistula. He underwent right hemicolectomy, fistula en bloc excision, and distal gastrectomy surgery with gastrojejunostomy and ileocolic anastomosis. Radiologic modalities are necessary before surgery. Surgery is the only curative treatment in benign cases and reconstruction method is dependent on patient's situation.

A novel succinate dehydrogenase type B mutation in an Iranian family. Its genetic and clinical evaluation.

Succinate Dehydrogenase-B (SDH-B) gene mutations constitute one of the most frequent forms of hereditary paragangliomas (PGL). Genetic study is advised in all cases for the evaluation of tumour behaviour, the selection of optimal management and the surveillance of the first degree relatives. There are limited data on the genetic characteristics of patients with PGLs from Middle East countries, and to our knowledge this is the first study from Iran. We present the clinical and genetic characteristics of a 29-year old woman who presented with hypertension secondary to a para-aortic PGL. She was shown to have a novel mutation in the SDH-B gene and her family was subsequently screened. We also emphasize the problems in diagnosing and treating patients in this region.

Sentinel lymph node mapping and biopsy using radioactive tracer in gastric cancer.

BACKGROUND: Lymph node metastasis is one of the most important prognostic factors in gastric cancer survival. Sentinel lymph node (SLN) mapping and biopsy may reduce the extension of lymph node dissection by determination of lymph node involvement. The current study prospectively evaluates the feasibility and reliability of SLN biopsy in gastric cancer. METHODS: A total of 30 patients with gastric cancer with a preoperative imaging stage of T1-T2 or T3, N0 and M0 were enrolled in the study. Furthermore, 2-16 h prior to each operation, (99m) Tc-sulphur colloid solution (0.5 mL, 2 mCi/mL) was endoscopically injected into the submucosal layer around the primary lesion. Lymph nodes were examined using a hand-held gamma probe. Subsequently, a total or subtotal gastrectomy and D2 lymphadenectomy was performed in each patient. RESULTS: The success rate of SLN biopsy was 100%. Sensitivity, specificity, positive predictive value and negative predictive value were 91.7%, 100%, 100% and 75%, respectively. Both of the two false-negative cases were in the T3 group. In cases of T2 tumours, the sensitivity was 100%. DISCUSSION: SLN biopsy using a gamma probe in early stage gastric cancer seems to be a safe, feasible and accurate procedure with high sensitivity in predicting regional lymph node involvement.

Botulinum toxin injection versus lateral internal sphincterotomy for the treatment of chronic anal fissure: randomized prospective controlled trial.

PURPOSE: Lateral internal sphincterotomy has been the gold standard treatment for chronic anal fissure, but it still carries the risk of permanent damage of the anal sphincter, which has led to the implementation of alternative treatment like botulinum toxin injection. The aim of this randomized prospective controlled trial was to compare the efficacy and morbidity of botulinum toxin injection and lateral internal sphincterotomy in the treatment of chronic anal fissure. METHODS: Fifty consecutive adults with chronic anal fissure were randomly treated with either lateral internal sphincterotomy or botulinum toxin (BT) injection with 50 U BT into the internal sphincter. The complications, healing and recurrence rate, and incontinence score were assessed 2, 3, 6, 12 months after the procedure. RESULTS: Inspection at the 2-month visit revealed complete healing of the fissure in 11 (44 %) of the patients in the BT group and 22 (88 %) of the patients in the lateral internal sphincterotomy (LIS) group (p = 0.001). At the 3-month visit, there was no significant difference between the two groups in healing. The overall recurrence rate after 6 months in the BT group was higher than in the LIS group (p < 0.05). In the 3-month follow-up, the LIS group had a higher rate of anal incontinence compared to the BT group (p < 0.05). The final percentage of incontinence was 4 % in the LIS group (p > 0.05). CONCLUSIONS: The treatment of chronic anal fissure must be individualized depending on the different clinical profiles of patients. Botulinum toxin injection has a higher recurrence rate than LIS, and LIS provides rapid and permanent recovery. However, LIS carries a higher risk of anal incontinence in patients.

Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.