Histopathologic Changes of Appendicitis Stage During the COVID-19 Pandemic.

Background: We decided to compare the pathology stage of appendicitis in patients referred to Firoozabadi Medical Center before and after the official announcement of the coronavirus outbreak in Iran because we believe that people's fears of COVID-19 are keeping them away from hospitals and it likely causes them to come in later stages of the disease. Therefore, this study aims at investigating the effect of the COVID-19 pandemic on the stage of appendicitis at presentation. Methods: In this retrospective study, histopathology records of all acute appendicitis patients who underwent an emergency appendectomy in the surgical unit in our institute between December 2019 and April 2020 were reviewed retrospectively. The study period was designed to include 2 months before and 2 months after the officially announced onset of the COVID-19 outbreak in Iran on February 20, 2020. All cases of complicated appendicitis (perforated appendicitis, phlegmonous appendix, itis or abscess) were excluded. Descriptive statistics were used to describe our study variables. Furthermore, ordinal logistic regression was used to investigate the effect of the COVID-19 pandemic and demographic variables on the stage of appendicitis at presentation. Data were analyzed using SPSS Statistics Version 22. Results: The study was conducted on 170 clinically diagnosed acute appendicitis patients. The odds ratio for gender was equal to 0.45 (0.23, 0.86), which means that women presented at an earlier pathological stage than men ( p = 0.016). Also, patients who had health insurance were 50% less likely to present in later pathological stages than those who did not ( p = 0.024). The COVID-19 outback did not have a significant role in the pathological stage at presentation ( p = 0.235). Conclusion: The number of appendicitis patients was down by about 50% following the outbreak announcement in Iran. Surprisingly, we did not find any significant changes in the distribution pattern of appendicitis pathological staging after the outbreak. Being uninsured and male sex were found to have the most significant roles in delayed hospital presentation and higher pathological stages in patients with acute appendicitis.

Changes in Body Composition, Basal Metabolic Rate, and Blood Albumin during the First Year following Laparoscopic Mini-Gastric Bypass.

Bariatric surgery is currently the only method that can significantly and continuously reduce weight and improve obesity-related comorbidities in morbidly obese patients. Significant weight loss through bariatric surgery can lead to changes in body composition. This study shows the changes in body composition, basal metabolic rate (BMR), and serum albumin in obese people following bariatric surgery. The study included 880 patients who underwent laparoscopic mini-gastric bypass surgery (LMGBP) between 2016 and 2020. The body mass index (BMI), bioelectrical impedance analysis (BIA), age, gender, blood albumin, WC (waist circumference), HC (hip circumference), BMR, and blood albumin were recorded at 0, 3, 6, and 12 months, postoperatively. The reduction in serum albumin concentration was not consistent with weight loss. Bariatric surgery promotes the breakdown of both fat and lean mass on the arms, torso, and thighs. This size reduction usually aggravates the concomitant skin redundancy in these areas which is a challenge for the plastic surgery team. Interestingly, the rate of lean mass reduction of the arms is faster than that of the torso and thighs. Excessive loss of lean body mass will also lower BMR and lead to subsequent weight gain. Despite the faster loss of proteins and lean mass in somatic areas, internal organs and viscera lose fats faster than proteins. According to this study, visceral proteins are the latest proteins to be affected by weight loss. This finding shows a different metabolic response of viscera comparing to somatic areas.

An interesting case of inflammatory myofibroblastic tumor presenting as cholangiocarcinoma.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) is a reactive or inflammatory state mostly affecting the pulmonary system and commonly occurs in children and young adults. IMT presentation in the hepatic duct bifurcation is very rare and has sporadically been reported before. PRESENTATION OF CASE: A 12-year-old girl presented with jaundice, pruritus which had begun 5 weeks previously. Ultrasound revealed intrahepatic biliary ductal dilation and an isoechoic 25*30mm lesion at or near the confluence of the right and left hepatic ducts that were suggestive of a hilar cholangiocarcinoma. Limited resection was decided intraoperatively because the intraoperative frozen section assessment of the CBD, right and left hepatic duct wall samples and porta hepatis lymph nodes was normal. Histologically the tumor proved an inflammatory myofibroblastic tumor (IMT). DISCUSSION: Almost all patients with resectable IMT should be managed with radical surgical resection or single nonsteroidal anti-inflammatory drugs. In addition, conservative treatments with NSAIDs, corticosteroids or chemotherapeutic agents could not be started in many cases due to the lack of definitive diagnosis of the mass preoperatively. Thus, surgical removal is frequently unavoidable. CONCLUSION: Biliary IBT is extremely rare and should be considered by all hepatobiliary surgeons dealing with the teens with cholangiocarcinoma, to avoid unnecessary major surgical resections.

Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality.

INTRODUCTION: The mainstay of treatment for perforated peptic ulcer is Omental patch closure. With the advent of laparoscopic surgery, this approach is being used for the treatment of perforated peptic ulcer. The aim of this study was to evaluate the outcome of laparoscopy in Firoozgar general hospital over a period of 18 months. The outcome of the laparoscopic approach and the associated morbidity and mortality, operation time, conversion rate and hospital stay were assessed. METHODS: A prospective analysis of 29 consecutive patients (mean age 37.5 years; 23 men) with perforated peptic ulcers and who had undergone laparoscopic surgery was carried over a period of 18 months from March 2014 until September 2015. Pre-operative, intra-operative, and post-operative clinical data were collectively analyzed by SPSS 19 for Windows. RESULTS: Seventeen patients had a history of cigarette smoking, 11 patients had a history of opium consumption, 19 were chronic NSAID users, 26 had Helicobacter pylori infections, and six had a co-morbid condition. Previous surgical history included laparotomy for pancreatic cancer in two patients, for sigmoid colon cancer in one patient, and for acute appendicitis in four patients. The average operating time for all cases was 47.5 + 20 min. The mean lag time between onset of symptoms and surgery was 20.4 hours. All patients underwent laparoscopic closure of the perforation with Omental patch closure. No morbidity was observed, and none of the patients needed conversion to open surgery. One patient died after 11 months of follow-up due to the progression of underlying pancreatic cancer. The mean postoperative hospital stay was 4.2 days. CONCLUSIONS: The results of the laparoscopic approach for perforated peptic ulcer were promising, with no conversion to open surgery, no morbidity, and mortality.

Evaluating the Time Interval for Presenting the Signs of Hypocalcaemia after Thyroidectomy.

INTRODUCTION: Thyroidectomy is one of the most prevalent treatments for thyroid malignancies. It has very low rate of complications except the hypocalcaemia. Only a small number of studies have evaluated the clinical signs of hypocalcaemia but no study have reported the time interval between the procedure and signs of hypocalcaemia. AIM: The aim of this study was to determine that time interval in those patients. MATERIALS AND METHODS: Medical files of a group of patients who underwent thyroidectomy were reviewed. Demographic characteristics of the patients and the time interval to hypocalcaemia were recorded and analysed by SPSS software. p-value <0.05 was considered significant. RESULTS: One hundred and eight patients, 65 women (60.2%) and 43 men (39.8%) with a mean age of 42.6+12.2 years were included. Perioral numbness was reported in 30 (27.8%) patients while 29 (26.8%) patients had lip numbness. Numbness in extremities and muscle spasm were found in 19 (17.6%) and 13 (12%) patients respectively. Seizure was reported in 3 (2.8%) patients. The Trousseau and Chvostek signs were found in 17 (15.7%) and 9 (8.3%) patients respectively. Only the Trousseau sign was different between the two surgical groups. The mean time interval was 41.25±11.5 hours postoperatively. However the time interval was shorter for the total thyroidectomy. CONCLUSION: Physical examination is useful for diagnosing hypocalcaemia due to the presentation of sings during the first 48 hours of thyroidectomy. Total thyroidectomy is associated with shorter time interval.

Evaluating the accuracy of fine needle aspiration and frozen section based on permanent histology in patients with follicular lesions.

BACKGROUND: Fine needle aspiration (FNA) has led to a decrease in unnecessary surgeries for thyroid nodules. This study was designed to compare diagnostic value of FNA and frozen section methods in the follicular lesions. METHODS: This is a cross-sectional study based on the medical records of 42 patients who were referred to surgery clinic of Rasool-e-Akram hospital in Tehran with complaint of thyroid nodules. All FNAs were diagnosed as follicular lesions in pathologic evaluation. All the patients underwent thyroid surgery and their frozen section results were also assessed. Finally, diagnostic value of the two tests was compared based on final permanent histologic report. RESULTS: Forty two patients with follicular thyroid nodules diagnosed with FNA were included. During the operation, using frozen sections, diagnosis of papillary carcinoma, non-papillary malignancies, benign lesion and intermediate cytology was made in 13 (31%), 3 (7%), 25 (59.5%), 1 (2.5%) patients, respectively. RESULTS of permanent histology showed that follicular adenoma is the most prevalent lesion which appeared in 25 (59.5%) cases. Papillary and follicular carcinomas were detected in 10 (23.8%) and 4 (9.5%) cases, respectively. CONCLUSION: RESULTS of the study demonstrate a 73% reduction in second surgery in patients with follicular thyroid lesions based on intraoperative frozen section results.

The Demodex mites and their relation with seborrheic and atopic Dermatitis.

OBJECTIVE: To determine the prevalence of seborrhoeic dermatitis (SD) and atopic dermatitis (AD) between the Demodex folliculorum (D. folliculorum) positive and D. folliculorum negative patients and to investigate any possible relationship between the D. folliculorum mites and the presence of SD and AD. METHODS: In this cross sectional study, authors collected samples from the skin around the nasal tip of 180 randomized patients who reffered to Amir Al-Momenin Hospital dermatology clinic for skin erythema, scaling and pruritis, to examine the precence of demodicosis (D. folliculorum) infestation under optical microscope. Then authors assessed the prevalence of SD and AD between the D. folliculorum positive and D. folliculorum negative patients. Finally, data analysis using SPSS software and Chi-square test were performed. RESULTS: Our study showed no significant association between the demodicosis (D. folliculorum) and SD (P=0.68) and AD (P=0.70) prevalence. CONCLUSIONS: According to the result of this study, the eradication of Demodex mites probably is not effective to reduces the prevalence of both dermatitis. However further investigation on a larger scale in a case-control study in this area is recommended.

Cecal endometriosis presenting as acute appendicitis.

The aim of our paper is to show the diagnosis of Coecal endometriosis as an infrequent reason of right iliac fossa pain. cecal endometriosis manifesting with right lower quadrant pain is difficult to diagnose, and it may even sometimes require laparotomy for diagnosis and treatment. We report here a case of cecal endometriosis causing clinically resembled acute appendicitis. In our patient, a diagnosis of cecal endometriosis was made postoperatively by microscopic examination of excised right colon, and the patient symptoms and general condition were improved after the surgery (open right hemicolectomy and ileocolic anastomosis).