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INTRODUCTION: Appendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis. CASE PRESENTATION: A 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days. DISCUSSION: Acute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage. CONCLUSION: This rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.
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BACKGROUND: This study was designed to assess the clinical judgment of medical students in surgery clinical decision-making by a standard examination after lecture-based learning (LBL) or problem-based learning (PBL). MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students whom were randomly allocated to three groups was performed during November 2017 and January 2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by an intern. Chi-squared test and independent student t-test were used to compare between the two groups. All the analyses were performed by the two-sided method using the Statistical Package for the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set as statistically significant. RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple-choice examination, compared to the LBL group (P = 0.048). However, there was no significant difference between the PBL group led by an attending and the PBL group led by an intern (P = 0.892). CONCLUSION: We concluded that PBL remarkably increased the students' scores in the problem-solving examination, as compared to the conventional method. We found no significant differences in PBL facilitated by an attending or an intern.
ABSTRACT
INTRODUCTION: Bariatric surgeries are the only effective long-term treatment in obese patients. The innovation of laparoscopic gastric plication (LGP) raised some questions about its effectiveness compared to traditionally used techniques such as laparoscopic sleeve gastrectomy (LSG). We tried to answer some of these questions. MATERIALS AND METHODS: We investigated 70 patients in a randomized clinical trial (IRCT2013123012294N5) from 2012 to 2015. Thirty-five patients were randomly assigned to each LSG or LGP group, using sealed envelope method. The body mass index (BMI) reduction and the percentage of excess weight loss (%EWL) along with %total body weight loss (%TWL) were primary endpoint and were assessed at follow-up periods. We recorded postoperative complications, as well. RESULTS: Two-year follow-up rate was 100%. There were no statistically significant differences between the two groups in means of preoperative BMI. Also, postoperative follow-ups were not suggestive for a significant difference in BMI (all p values > 0.05). The mean %EWL at follow-ups showed no significant difference at any point, except for 3 and 6 months after surgery (p value = 0.002 and 0.017, respectively). This finding was confirmed by %TWL trend in 12 months after surgery. LSG patients were readmitted more than LGP patients (seven cases vs one case, p value = 0.024). Postoperative complications such as nausea and vomiting, hair loss, iron deficiency, vitamin D deficiency, and cholelithiasis were not different between the two groups. There was one death in the LGP group due to pulmonary thromboembolism. CONCLUSIONS: LGP showed to be efficient regarding %EWL and %TWL reduction in short-term follow-ups with comparable postoperative complications to LSG.