Duodenojejunostomy following failed gastrojejunostomy in superior mesenteric artery syndrome: A case report.

INTRODUCTION: Superior mesenteric artery (SMA) syndrome is a rare duodenal-vascular anatomic disorder leading to external compression on the duodenum. The first step of treatment usually is conservative, and in the case of failure, surgical management is the treatment choice. Treatment success with duodenojejunostomy after failure in gastrojejunostomy can show the uniqueness of this article. CASE PRESENTATION: A 14-year-old boy came to our hospital with a complaint of epigastric pain, nausea, bilious vomiting, and weight loss since 6 months ago. Conservation therapy and laparotomic Braun anastomosis and gastrojejunostomy was performed due to the SMA syndrome diagnosis 2.5 months before the admission. At our hospital, an alteration of gastrojejunostomy by duodenojejunostomy employing a diamond-shaped anastomosis between the third portion of the duodenum (D3) and a part of jejunum that was placed 15 cm away from the ligament Treitz was done. A significantly dilated stomach and the first three parts of the duodenum were observed during the procedure. After the second surgical intervention, the general condition of the patient dramatically improved. CLINICAL DISCUSSION: Conservative treatment, including nasogastric tube decompression, postural changes, and nutritional support with hyperalimentation, has a variable success rate. However, in some cases, surgery may be necessary. Surgeons prefer laparoscopic duodenojejunostomy due to its outstanding success rate, ranging from 80 % to 100 %. But, in some case reports it is suggested that gastrojejunostomy could be done in cases with severe duodenal dilation instead of duodenojejunostomy. The initial gastrojejunostomy failed because of ongoing symptoms, which was finally revised with a duodenojejunostomy. CONCLUSION: It is suggested to use duodenojejunostomy after failure of gastrojejunostomy or it can be employed as the first surgical option even in cases with severe dilation. Because it is a more efficient correction with fewer complications than gastrojejunostomy.

Rapid Growth of Hydatid Cyst: A Pediatric Case Report.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus with worldwide distribution. The most affected organs are liver and lungs, but it can be detected in any other organs as well. We reported a 5-yr-old boy from Shiraz, southern Iran in 2017 who presented with abdominal discomfort. Imaging revealed multiple liver hydatid cyst and a huge kidney hydatid cyst. This case showed the possible implication of rapid growth of multiple hydatid cyst as well as unusual organ presentation in the pediatric population.

Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports.

Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.

The Relationship between Dietary Patterns with Blood Pressure in Iranian Army Staffs.

BACKGROUND: Hypertension is one of the most common noncommunicable diseases in the world. One of the most effective factors on blood pressure (BP) is nutrition. The aim of this study was to examine the relationship between dietary patterns and BP among military staffs. MATERIALS AND METHODS: The study was carried out among 405 military staffs between 22 and 51 years old. Demographic, anthropometric information, and BP of participants were evaluated by standard methods. The dietary intakes were collected using a food frequency questionnaire (FFQ). Dietary patterns were identified using a posteriori method, factor analysis, and based on the FFQ. To check the relationship between BP and dietary patterns, we used multivariate linear regression in different models, relationship were adjusted for Age, sex, marital, smoking, income, body mass index, waist-to-hip ratio, family history of hypertension, energy intake, and physical activity level. RESULTS: Two dominant dietary patterns were identified in the participants: Healthy and western pattern. The association of dietary patterns with systolic BP (SBP) and diastolic BP (DBP) was exhibited in different models. There was no relationship between SBP and DBP with healthy pattern (P = 0.269 and P = 0.638, respectively) and western pattern (P = 0.648 and P = 0.315, respectively) after adjustments. CONCLUSION: Our findings indicated that dietary patterns did not have any significant relationship with SBP and DBP after adjustment for confounders in the healthy military. To identify the dietary patterns associated with BP in healthy military, more strong design studies and more participants should be conducted in the future.

The effect of vitamin D supplementation on blood sugar and different indices of insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD).

BACKGROUND: Vitamin D supplementation has been shown to decrease insulin resistance through which it might cause fatty liver. Fatty liver increasingly results in type 2 diabetes mellitus (T2DM). Insulin resistance and fatty liver are particularly closely related. The aim of present study is to examine the effect of vitamin D supplementation on blood sugar and different indices of insulin resistance in patients with non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: This randomized placebo-controlled clinical trial was conducted on 60 patients with NAFLD, who were divided equally into intervention and control groups. Patients in the intervention group received vitamin D3 (50,000 IU) and patients in the control group received placebo capsules every week for 10 weeks. Blood sugar, homeostatic model assessment-insulin resistance (HOMA-IR), and homeostatic model assessment-beta cell (HOMA-B) were checked at baseline and after 10 weeks of the intervention. Adjustment for variables was performed by analysis of covariance (ANCOVA). RESULTS: Vitamin D supplementation resulted in increased serum 25-hydroxy vitamin D [25(OH) D] concentration in the intervention group compared to the control group [+68 (12) vs. -1.9 (2.44); P = 0.001]. Intake of vitamin D supplements led to a marginally significant decrease in fasting blood glucose [FBS: -12 (4) in the intervention group compared to - 3 (2) in the control group; P = 0.055]. Also, HOMA-IR decreased in the intervention group compared to the control group [-1.75 (0.23) vs. 0.12 (0.41); P = 0.066]. CONCLUSIONS: Vitamin D supplementation resulted in decreased HOMA-IR and FBS concentration in patients with NAFLD; however, it did not affect the insulin level and HOMA-B significantly.

Relationship between non-alcoholic fatty liver disease and inflammation in patients with non-alcoholic fatty liver.

BACKGROUND: Non-alcoholic fatty liver is the most chronic liver disease that eventually can become cirrhosis. One of the underlying assumptions for the fatty liver created by inflammation of the hepatocytes. We aimed to assess the association between non-alcoholic fatty liver disease (NAFLD) and sub-clinical inflammation. MATERIALS AND METHODS: This is a cross-sectional study which was conducted on 55 patients over 30 years, with NAFLD. Fatty liver grade was assessed using liver ultrasound. Liver enzymes (alanine aminotransferase, aspartate aminotransferase), anthropometric characteristics and inflammatory marker C-reactive protein (CRP) were measured. Qualitative variables (sex and fatty liver grade) and quantitative variables such as were compared with independent t-test and Chi-square test. Relationship between fatty liver grade and inflammatory index was assessed with SPSS software (version 20; SPSS, Inc. Chicago, IL, USA). RESULTS: Non-alcoholic fatty liver grades were associated with CRP level and this relationship remains in statistically significant level even after adjusting the effects of confounding variables such as age, sex and body mass index of participants (P = 0.016). CONCLUSION: In this cross-sectional study, presentation of NAFLD showed a significant correlation with sub-clinical systemic inflammation and CRP level.

Stroke and nutrition: a review of studies.

BACKGROUND: Stroke is one of the leading causes of death and certainly the major cause of disability in the world. Diet and nutrient has an effective role in prevention and control of the risk of stroke. The aim of this study was to review the studies on the relationship between dietary intake and stroke incidence. METHODS: In this study, the terms of "Fat", "cholesterol", "antioxidant", "vitamins", "salt", "potassium", "calcium", "carbohydrate", "vegetables", "fruits", "meat", "tea", "whole grains", "sugar-sweetened beverages", "Mediterranean diet", "dietary approaches to stop hypertension diet (DASH diet)", "Western diet", and "stroke" were searched in Pubmed search engine. The observational studies, cohort studies, clinical trial studies, systemic review, and meta-analysis reviews are also included in this study. RESULTS: The study revealed that adherence to theimprovements in nutrition and diet canreducethe incidence ofstroke. Higher antioxidant, vitamins, potassium, calcium, vegetables, fruits, whole grain intake, and adherence to the Mediterranean dietor DASH diet can lower stroke incidence. CONCLUSIONS: Adherence to Mediterranean diet or DASH diet and increasing the consumption of antioxidant, vitamins, potassium, calcium food sources, vegetables, fruits, and whole grains intake can lower the risk of stroke. Healthy diet is effective in reducing risk of stroke, however, more studies need to be carried out in this area.

Role of routine pelvic radiography in initial evaluation of stable, high-energy, blunt trauma patients.

BACKGROUND: Pelvic fractures are among the most devastating traumatic injuries accompanied by high morbidity and mortality rate leading to catastrophic outcomes and haemodynamic consequences. Although Advanced Trauma Life Support (ATLS) recommends performing pelvic radiography in all major blunt trauma patients, several lines of evidence recommend that it can be limited to those blunt trauma patients who are haemodynamically unstable or have positive pelvic physical examination. Thus, we performed this study in order to evaluate the efficacy of routine pelvic radiography in haemodynamically stable, high-energy, blunt trauma patients. METHODS: This was a prospective cross-sectional study including all the haemodynamically stable, high-energy, blunt trauma patients with negative pelvic physical examination referring to our trauma centre during a 5-month period (May-September 2010). Pelvic radiographies were performed and reviewed for abnormalities. In those who had negative pelvic physical examination and the radiography was not revealing enough, CT imaging was requested and reviewed. RESULTS: During the study period, 1679 high-energy blunt trauma patients referred to our centre out of which 389 were haemodynamically stable and had negative pelvic physical examination. Pelvic radiography was found to be normal in all the patients except one (0.25%) who had pelvic fracture. Only three patients required CT imaging out of which two (0.5%) were found to be normal. CONCLUSIONS: Pelvic radiography could be eliminated from the primary survey protocol of the patients with high-energy blunt trauma who are haemodynamically stable and have negative pelvic physical examination.

Role of cervical spine radiography in the initial evaluation of stable high-energy blunt trauma patients.

BACKGROUND: Detecting cervical spine injuries in trauma patients is essential because undetected injuries in the this area may result in severe neurological disability and probably quadriplegia. Thus, radiography of the cervical spine is considered mandatory in the initial evaluation of trauma patients according to Advanced Trauma Life Support. This approach results in many unnecessary normal radiographs. Therefore, we performed this study to determine the role of routine cervical radiography in the initial evaluation of stable high-energy blunt trauma patients. METHODS: This was a prospective cross-sectional study including all hemodynamically stable high-energy blunt trauma patients with negative cervical physical examinations referred to our trauma center during a 5-month period (May to September 2010). Cervical radiographs, computed tomography (CT) scanning and magnetic resonance imaging were performed and reviewed for abnormalities. RESULTS: During the study period, 1,679 high-energy blunt trauma patients were referred to our center, of which 400 were hemodynamically stable and had negative cervical physical examinations. Cervical radiographs were found to be normal in all patients. CONCLUSION: Cross-table cervical spine radiographs can be limited to those high-energy blunt trauma patients who have a positive cervical physical examination or those in whom the physical examination is not revealing. These radiographs also have low value for detecting occult cervical spine fractures, and CT imaging is considered the modality of choice in these cases.