Peroneal/posterior tibial nerves delayed dysfunction due to traumatic popliteal artery pseudoaneurysm resulting from trivial stab wound: A case report.

BACKGROUND: Popliteal artery pseudoaneurysms due to stab wounds are extremely rate. Even more infrequently, they can contribute to the compression of multiple peripheral nerves. CASE DESCRIPTION: A 23-year-old male, following a trivial stab wound, developed the delayed occurrence of a pseudoaneurysm of the popliteal artery. This resulted in the delayed onset of a compressive popliteal/posterior tibial neuropathy. Following restoration of blood flow through the popliteal artery utilizing saphenous vein grafting, additional neurolysis resulted in resolution of the compressive neuropathy. CONCLUSION: A 23-year-old male developed a pseudoaneurysm following minor trauma that resulted in peripheral nerve dysfunction.

A Single-Center Report on Liver Transplantation: First Experiences from Shahid Beheshti University of Medical Sciences.

BACKGROUND In the Middle East, data on liver transplantation (LT) are limited, and reports on LT from this region are of specific value. The purpose of this study is to report our 8-year experiences and challenges with LTs in our center to improve the outcomes. METHODS 116 patients received whole organ graft from deceased donors, and orthotopic liver transplantation was performed at Taleghani hospital, between January 2009 and July 2017. The patients were prioritized according to Model for End-Stage Liver Disease (MELD) score and Child-Pugh classification. RESULTS The most common postoperative complication was sepsis (16%), although the most common surgical post LT complication was postoperative bleeding. The most common cause of death was primary graft dysfunction (21.9%). Following LT, 50% of the deaths (n = 16) occurred during the first 10 days. Cumulative survival rates were 78.4%, 77.6%, and 66.7% at 1 month, 1 year, and 5 years, respectively. CONCLUSION This report provides invaluable experience from a region where data on LT is largely missing due to the absence of official registration programs. The data could be used to improve the LT program in the region.

First successful combined heart and kidney transplant in Iran: a case report.

Combined heart and kidney transplant has become an accepted therapy for patients with coexisting heart and kidney failure. This method, compared with single-organ transplant, has a better outcome. Here, we report the first successful combined heart and kidney transplant in Iran. The patient was a 36-year-old man with end-stage renal disease owing to IgA nephropathy, admitted to Masih Daneshvari Hospital in Tehran, Iran for progressive dyspnea and chest pain. In-patient evaluations revealed cardiomyopathy leading to end-stage heart failure. Owing to concurrent heart and kidney end-stage diseases, combined cardiorenal transplant was done. Eight months after his transplant, routine follow-ups have not shown any signs of acute rejection. He is now New York Heart Association functional class I. Both cardiac and renal functions are within normal ranges. Good outcome during follow-up for this case justifies simultaneous heart plus kidney transplants as an alternate treatment for patients with advanced disease of both organs.

Perforated peptic ulcer disease: mid-term outcome among Iranian population.

BACKGROUND/AIMS: The aim of this study was to evaluate midterm outcome of patients with perforated peptic ulcer disease and to determine the main predictors of mid-term mortality. METHODS: Demographic and clinical characteristics of 56 patients with the diagnosis of perforated peptic ulcer who were hospitalized in Taleghani Hospital over a 10-year period (19962005) were retrospectively collected, and in-hospital mortality and morbidity were determined. Patients were also followed for one month, one year and five years after the operation. RESULTS: Among these patients, 85.5% were treated with omental patch closure, 7.1% underwent vagotomy pyloroplasty, 5.3% underwent concurrent vagotomy and gastrojejunostomy, and 1.8% underwent antrectomy. In-hospital mortality and morbidity were 5.3% and 48.2%, respectively. Survival rates at one month, one year and five years after the operation were 92.9%, 89.3% and 78.6%, respectively. Advanced age (p=0.001), preoperative shock (p=0.003), history of malignancy before surgery (p=0.001), treatment delay (p=0.028), intensive care unit admission (p=0.032), and size of ulcer >5 cm (p=0.043) were the main predictors of five-year mortality in the followed patients. CONCLUSIONS: Mid-term mortality of treated perforated peptic ulcer disease among our population was notable, and the main predictors of mortality included advanced age, history of malignancy, treatment delay, intensive care unit admission, and ulcer size.

Knowledge, attitude, and practice of Iranian surgeons about blood-borne diseases.

BACKGROUND: Perhaps more than any other healthcare worker, it is the surgeons who are at an increased risk of exposure to hepatitis B (HB) virus, hepatitis C virus, and human immunodeficiency virus. The aim of this study was to evaluate surgeons' concerns regarding risk awareness and behavioral methods of protection against blood-borne pathogen transmission during surgery. MATERIALS AND METHODS: A 31-item questionnaire with a reliability coefficient of 0.73 was used. Of 575 surgeons invited to participate from three universities and one national annual surgical society between May and July 2007, 430 (75%) returned completed forms. RESULTS: Concern about being infected with blood-borne diseases was more than 70 (from a total score of 100). Only 12.9% of surgeons always used double gloves. Complete vaccination against HB was done in about 76% of surgeons and only 56.8% had checked their HB surface antibody (anti-HBs) level. Older surgeons never used double gloves (P = 0.001). CONCLUSION: Iranian surgeons are not aware of the correct percentage of infected patients with and seroconversion rate of blood-borne diseases, do not use double gloves adequately, do not report their needlestick injuries, vaccinate against HB, and check anti-HBs after vaccination. Educational meetings, pamphlets, and facilities must be provided to health care workers, informing them of hazards, prevention, and postexposure prophylaxis to needlestick injuries, vaccination efficacy, and wearing double gloves.

Obstructive jaundice in Iran: factors affecting early outcome.

BACKGROUND: Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival. This study aimed to assess baseline etiologies, clinical manifestations, diagnostic results, and morbidity and mortality related to obstructive jaundice in Iranian patients. METHODS: The hospital recorded files of 133 patients with the final diagnosis of obstructive jaundice who had been admitted to the Taleqhani Hospital in Tehran between January 2001 and September 2004 were reviewed. RESULTS: The most common etiologies of obstructive jaundices were neoplasia and then common bile duct stone in the two genders. The results of ultrasonography were positive in less than half of the patients. However, the most positive results were related to endoscopic retrograde cholangiopancreatography (ERCP). The in-hospital mortality rate in patients less than 50 years old and elderly patients was 0% and 6.76%, respectively. The in-hospital morbidity rate was 2.25% and 7.51%, respectively in both patients and it was commonly related to infection of ulcer (44.46%), pneumonia (14.75%), myocardial infarction (14.75%), and subdiaphragmatic abscess (11.29%). In patients with a diagnosis of benign obstruction, only one patient died of severe sepsis. In malignant group, preoperative characteristics, such as weight loss (P=0.015) and serum bilirubin concentration more than 16 mg/dl and postoperative complications, such as sepsis (P<0.001), cardiac arrest (P<0.001), and hepatic coma (P<0.001) were main predictors for the in-hospital mortality rate. CONCLUSION: Although the mortality and morbidity of obstructive jaundice in our study are less than those in other studies, the determination of preoperative clinical and laboratory indices and postoperative complications of patients is needed for the control of mortality and morbidity rate.

Treatment of infected pseudoaneurysm in drug abusers: ligation or reconstruction?

BACKGROUND: Recently, there has been an increase in the incidence of major vascular complications such as infected pseudoaneurysm due to intravenous drug use. OBJECTIVE: For better understanding of the existing controversies regarding the optimal surgical management of infected pseudoaneurysm, the present study was conducted. METHODS: Medical charts of 36 consecutive patients who underwent surgery in Taleghani Hospital, Tehran, Iran from 1996 through 2003, were retrospectively analyzed. RESULTS: We studied the hospital records of 33 cases; two patients had bilaterally infected pseudoaneurysms and one underwent an emergency reoperation. The total number of operations was 36. Eleven cases (30.5%) underwent ileofemoral reconstruction and 25 (69.5%) arteries were ligated. All patients presented with infected femoral or brachial pseudoaneurysms due to intravenous drug abuse. Postoperatively, there was no hemorrhage, vascular thrombosis, amputation, or mortality. Three cases (8%) had incisional infections (2 [18%] after reconstruction and 1 [4%] after ligation operation) and 7 patients (19%) had claudication (all after ligation). CONCLUSION: Ligation is the optimal management for infected pseudoaneurysm, because it is easy, cost-effective, and safe. Reconstruction is not recommended, because of an extended infection at the location of pseudoaneurysm and at the artificial graft site.