Idiopathic true aneurysm of the proximal radial artery with the appearance of an enlarging mass: A case report.

INTRODUCTION AND IMPORTANCE: Aneurysm of the radial artery is one of the rare cases in the field of vascular surgery, and its diagnosis and management is one of the challenges in this era. Without proper diagnosis and treatment, it may affect the patient's lifestyle and reduce the quality of life because of pain and limitation in activity. Importantly, it may cause limb or life threatening complications including arterial thromboembolism and aneurysm rupture. CASE PRESENTATION: A 50-year-old woman was presented with a true proximal right radial artery aneurysm with the manifestation of an enlarging mass since 2 years ago, which had gradually become painful. The radiologic investigations revealed the presence of an aneurysm in the proximal radial artery. The patient underwent surgery consisting of ligation of the radial artery proximal and distal to the aneurysm and excision of the aneurysm sac. Pathologic examination confirmed the diagnosis. CLINICAL DISCUSSION: Any enlarging mass in the pathways of arterial branches can be arterial aneurysm, even if not pulsatile. Prompt physical examination and imaging modalities can help for diagnosis and decision making for either segmental arterial resection or vascular reconstruction. CONCLUSION: Radial artery aneurysm, as a rare but potentially devastating arterial disease should be in differential diagnosis of any forearm mass and managed promptly.

Protein C deficiency: Report of a challenging case with recurrent multiorgan thrombosis.

INTRODUCTION AND IMPORTANCE: Protein C deficiency is a rare disorder associated with an increased risk of developing abnormal blood clots. Mild and heterozygous cases are usually asymptomatic and may present with recurrent thrombosis. These recurrent thrombi are usually associated with ischemic stroke or concomitant thrombosis during pregnancy and recurrent miscarriage, but arterial thrombosis is relatively uncommon. CASE PRESENTATION: In this case report, we introduce an interesting 21-year-old female patient with a protein C deficiency, which presented with a set of symptoms related to ischemia and thrombosis in several different systems, including the colon, brain, and lower extremities. CLINICAL DISCUSSION: With the diagnosis of ischemic colitis, she underwent medical treatment with hydration, antibiotics, anticoagulant, and GI rest. She was discharged with a suitable response to medical treatment and good general condition. One month later, the patient presented with right upper limb paresis and speech disorder, and at the same time, he had swelling of the left lower limb. The patient was diagnosed with DVT of the common femoral vein and protein c deficiency and treated appropriately with anticoagulant (heparin 1000 lU/h) and was discharged with oral rivaroxaban after symptoms improved. CONCLUSION: In young patients with ischemic colitis without a history of previous surgery, increased coagulation should be considered, including impaired fibrinolysis and impaired microcirculation and inflammatory processes. Protein C deficiency is one of several reasons for thrombotic disorders that should be considered in these people, especially if they have a history of DVT or other vascular thromboses.

Effect of Laparoscopic Sleeve Gastrectomy vs. OAGB on Thyroid Function Tests in Patients with Morbid Obesity and Subclinical or Clinical Hypothyroidism.

PURPOSE: As one of the major problems for the health sector, morbid obesity is associated with many hormonal dysfunctions, including thyroid hormone disorders. Few studies have been performed on improving subclinical and clinical hypothyroidism following bariatric surgery. Therefore, we designed and conducted this study to evaluate the effect of various types of bariatric surgery on thyroid hormone levels and to assess the change of levothyroxine requirement in these patients. METHODS: The data of all patients who underwent either sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB) surgery in the 5 years from 2016 to 2020 at our hospital were analyzed retrospectively. RESULTS: From 1486 patients (792 cases of SG and 694 cases of OAGB), 281 patients had preoperative abnormal thyroid function tests: subclinical hypothyroidism (102 patients) and clinical hypothyroidism (179 patients). The T4 level did not change significantly in any of the groups and subgroups. However, the TSH level at the end of the sixth month after SG and OAGB in both groups significantly lowered. Nevertheless, there is no significant difference between the effect of SG and OAGB surgical procedures on the rate of TSH and T4 alterations in both subclinical and clinical hypothyroid patients. In the sixth month after surgery, 49% of clinically hypothyroid patients in the SG group (n = 179) reduced or stopped taking the medication. CONCLUSION: Whereas bariatric surgery reduces TSH levels, it does not significantly alter T4 levels. Furthermore, there is no apparent difference between subclinical and clinical hypothyroidism and different types of bariatric surgery.

Ovarian vein and IVC thrombosis due to normal vaginal delivery; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Ovarian vein thrombosis (OVT) is exceedingly rare, which commonly occurs in postpartum patients and can result in serious complication such as pulmonary emboli. With a presentation often mimicking that of acute abdomen, it can be often misdiagnosed and mistreated. CASE PRESENTATION: A 30-year-old woman referred with right lower quadrant abdominal pain, nausea and anorexia, one week after normal vaginal delivery. Physical examination demonstrated tenderness and rebound tenderness at the right side of the abdomen, with a stable vital sign except 38 °C fever. She had no history of coagulation problems or thrombotic disorders. Patient was admitted on a suspicion of appendicitis and was prescribed antibiotics followed by pelvic and abdominal ultrasonography that indicated an 8 to 10-centimeter hypoechoic tubular structure on the right side, next to the IVC. CT scan with contrast showed clear dilatation and thrombosis of the right ovarian vein with spread to the IVC. Anticoagulant treatment was started with 1000 intravenous units of heparin per hour, along with aPTT control, with a disappearance of the symptoms after 72 h. CONCLUSION: Suspicion of OVT should be high in cases where patients refer with abdominal pain after childbirth, this diagnosis should be taken into account. In the absence of proper and timely diagnosis, it may lead to serious complications or mortality of the mother. CT scan with contrast and at least 3- months anticoagulant therapy (in case of thrombosis spreading to the IVC, this period should be extended) is recommended in diagnosing and treatment of OVT.

Postoperative Outcomes and Advantages of Hand-Sewn Laparoscopic One-Anastomosis Gastric Bypass: Experience on 805 Patients.

PURPOSE: One-anastomosis gastric bypass (OAGB) is a novel laparoscopic approach. The anastomosis of OAGB can be sewn either with a stapler or manually. The aim of this study is to determine the outcome of hand-sewn OAGB. MATERIALS AND METHODS: A total of 805 consecutive patients were retrospectively enrolled in this study. Data collection included change in weight, body mass index (BMI), symptoms, and complications before surgery and continued during annual follow-up visits up to 5 years. Inclusion criteria were patients with a BMI of higher than 40 kg/m2 or higher than 35 kg/m2 with one severe comorbidity. Patients with BMI > 50 kg/m2 were referred to dieticians. RESULTS: The follow-up rate ranged from 93 to 50% at the 1-year and 5-year visits after surgery, respectively. Mean weight and BMI of patients before surgery were 121.93 kg (± 22.92) and 44.79 kg/m2 (± 6.07), respectively. Mean of annual BMI in 5 years of follow-up were 27.83, 27.26, 28.90, 29.45, and 29.56 kg/m2. Excess weight loss (EWL) in 5 years of follow-up were 85.7%, 89.5%, 78.9%, 77.7%, and 76.0%. Reflux was present in 202 patients (25.1%) before surgery and resolved in 153 cases (75.7%) 1 year after surgery. Procedure-specific early complication was an anastomosis leak in one patient, which led to death. Two cases of malnutrition necessitating reversal and two severe reflux disorders leading to Roux-en-Y bypass surgery were remarkable late complications. CONCLUSION: Hand-sewn anastomosis could represent an efficient and safe technique in the management of patients undergoing OAGB surgery with acceptable outcomes and rare adverse complications.