Catastrophic case of the total knee arthroplasty dislocation: A case report.

INTRODUCTION AND IMPORTANCE: Arterial injury is extremely rare after total knee arthroplasty. CASE PRESENTATION: We describe a 68-year-old woman with dislocation of total knee arthroplasty after falling from a height. She had a popliteal artery injury and a vascular bypass was performed in delay. The patient died of a second myocardial infarction 3.5 months after her first introduction to our center. CLINICAL DISCUSSION: Due to the prominent risk of vascular injuries after dislocation in TKA patients, we recommend performing vascular evaluations using CT angiography for all patients. CONCLUSION: Any untreated vascular compromise in the setting of TKA dislocation may lead to devastating outcomes such as amputation and death.

Simultaneous surgery of an inflammatory abdominal aortic aneurysm and renal cell carcinoma: A case report.

INTRODUCTION: Abdominal aortic aneurysm (AAA) and renal cell carcinoma (RCC) coincidence is considered a rare phenomenon. Moreover, the inflammatory nature of aneurysm increases the rarity of the case. PRESENTATION OF CASE: Our case was a 66-year-old man complaining of constant abdominal pain with a periumbilical pulsatile mass on examination. The computerized tomography angiography revealed a 67*41*44 mm AAA and a 52*43 mm renal mass. CLINICAL DISCUSSION: Not only choosing the most appropriate treatment is critical when two life-threatening diseases coexist in the same patient but also avoiding from any injury to adjacent organs while releasing fibrotic adhesions due to inflammatory process makes the case more challenging. CONCLUSION: The preset study describes the successful one-stage and open surgery for treatment of simultaneous IAAA and RCC.

Urinary Tract Bleeding as a Rare Manifestation of Uterine Artery Pseudoaneurysm.

Pseudoaneurysm of the uterine artery is a rare condition, which usually occurs after a traumatic birth, cesarean section, dilatation and curettage, and hysterectomy. This case is a 28-year-old female patient that presented with the chief complaint of severe urinary tract bleeding and hypovolemic shock. This patient underwent cesarean section 2 months before the first presentation. After the primary examination, the patient was sent to the hybrid operation room with the primary diagnosis of uterine artery pseudoaneurysm and coil embolization was done for treating the pseudoaneurysm. Considering continued bleeding, open surgery was performed and the internal iliac artery was ligated.

Management of celiac trunk and superior mesenteric artery synchronous aneurysms as an extremely rare manifestation of Wegener granulomatosis.

Large-vessel aneurysm is an extremely rare complication of Wegener granulomatosis. We report a case of Wegener granulomatosis in a 49-year-old woman with large synchronous aneurysms of the celiac trunk (54 mm) and superior mesenteric artery (42 mm) who presented with abdominal pain. Because of the large diameter of the aneurysms and their proximity to each other, a combination of endovascular and hybrid repair was used for management. After surgical debranching and endovascular repair, the patient was discharged in good general condition. We concluded that abdominal pain in Wegener granulomatosis can be a rare manifestation of a large visceral aneurysm.

Comparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access.

BACKGROUND: In candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical. OBJECTIVES: The present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications. PATIENTS AND METHODS: Sixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests. RESULTS: In the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen. CONCLUSIONS: This study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods.

Trends in epidemiology, clinical and histopathological characteristics of breast cancer in Iran: results of a 17 year study.

BACKGROUND: Breast cancer (BC) is the top cancer among women worldwide and the most frequent malignancy among Iranian women over the past few decades. The increasing trend and high mortality rate of BC in the developing world necessitates studies concentrating on its characteristics in countries in Asia. The current study focused on clinical and histopathological features of BC among Iranian females. MATERIALS AND METHODS: This retrospective study involved 714 Iranian patients with histopathologically proven BC undergoing resection of primary tumours and axillary clearance. Demographic, clinical and histopathological data were obtained and studied between ten year age groups (≤ 40 years, 41-50 years, 51-60 years, 61-70 years, and ≤ 71 years) in four chronologic phases from 1994-2009. RESULTS: Mean age of patients was 49.4 ± 13.1 years. Most of cases (33.2%) were in 41-50 group. Mean size of primary tumors was 3.94 ± 2.47 cm and 87.1% of cases had infiltrative ductal carcinoma. Modified radical mastectomy was the most common method of surgery carried out (48.8%). Some 57.1% of tumors were in pT2 and tumor size decreased significantly during the period (p<0.05). The most common BC stage was llla (27%). Lower BC stages (0 and 1) constituted 13.9% of the diagnosed tumors. Our series of patients aged ≤ 40 had larger tumors (mean 4.73 ≤ 3.02 cm) compared to older age groups (p=0.003). Lower stages (0 and I) were more frequent among the oldest patients while nearly 50% of patients aged ≤ 40 had tumor stage III. We also observed a significant decreasing trend in the mean LN count (p<0.05) and blood vessel invasion (p=0.023) from younger to older age groups. CONCLUSIONS: More aggressive disease for younger age groups, earlier peak incidence age and high rate of advanced BC at the time of diagnosis among Iranian women, were the main findings of this study.

A left paraduodenal hernia causing bowel obstruction: a case report.

A 41-year old mentally retarded patient presented acutely with a 3 day history of vomiting and absolute constipation. Intestinal obstruction was diagnosed following an abdominal x ray. At laparotomy, a left paraduodenal hernia was present, without incarceration of small bowel. The herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed.

Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty.

Percutaneous vertebroplasty (PVP) with polymethylmethacrylate (PMMA) is a minimally invasive procedure that provides significant pain relief in a high percentage of patients with osteoporotic fractures. The complication rate of PVP is reported to be below 6%. This case illustrates, for the first time, an arterial PMMA embolus to the aorta and its branches as a complication of PVP.

Peutz-Jeghers syndrome without mucocutaneous pigmentation: a case report.

Peutz-Jeghers syndrome is a rare condition characterized by mucocutaneous pigmentation, polyposis and an increased cancer risk at a number of gastrointestinal and extra intestinal organs. We present a patient with a history of gastrointestinal bleeding with no mucocutaneous pigmentation. Upper and lower gastrointestinal endoscopy revealed multiple polyps located in the deuodenum and colon. Histopathological evaluation of the polyps revealed hamartomatous polyps of Peutz-Jeghers syndrome.