A diagnostic challenge; pelvic solitary fibrous tumor (SFT) mimicking Peri-Anal gastrointestinal stromal tumor (GIST): A case report.

Key Clinical Message: The study reports a rare case of pelvic solitary fibrous tumor (SFT) that was initially considered as a peri-anal gastrointestinal stromal tumor due to similar radiologic/pathologic features. SFT diagnosis can be challenging due to its rarity and wide range of diagnoses that must be ruled out precisely. Abstract: Solitary fibrous tumors (SFTs) are rare tumors that can occur in any part of the body. Although usually benign, malignant SFTs have been reported, especially outside the lungs. Radiology can help with diagnosis, but immunohistochemistry is necessary to distinguish SFTs from other possible diagnoses such as gastrointestinal stromal tumors (GISTs). This study presents a rare case of pelvic SFT initially considered to be a peri-anal GIST, highlighting the importance of accurate diagnosis given the rarity of SFTs and the need to rule out other potential diagnoses.

Non-coding RNAs are correlated to TGF-ß receptor type 2 in patients with colorectal cancer.

BACKGROUND: Multiple molecular expression alterations, particularly in non-coding RNAs, play fundamental roles in the regulations of cellular processes and may relate to the occurrence and progression of colorectal cancer (CRC). In the present study, we investigated the associations between TGFBR2, miR20a-5p and long non-coding RNA (lncRNA) LAMTOR5-AS1 in CRC patients. METHODS: Colorectal cancer and adjacent normal tissue samples (n = 34) were prepared from CRC patients. The associations between TGFBR2, miR20a-5p and lncRNA LAMTOR5-AS1 were predicted using bioinformatics tools. The expression levels of TGFBR2, miR20a-5p and lncRNA LAMTOR5-AS1 were measured using a quantitative real-time polymerase chain reaction technique. The TGFBR2 protein values were measured by western blotting. The clinical importance of lncRNA LAMTOR5-AS1 was assessed using receiver operating characteristic curve. RESULTS: The up-regulated levels of TGFBR2 (p = 0.02), TGFBR2 protein (p = 0.008) and lncRNA LAMTOR5-AS1 (p = 0.02) were significantly observed in CRC tissues compared to the adjacent normal tissues. The miR20a-5p expression level (p = 0.009) was downregulated in CRC tissues. In addition, the miR20a-5p expression level was inversely correlated to the TGFBR2 gene (r2  = 0.88, p < 0.0001), protein (r2  = 0.95, p < 0.0001) and lncRNA LAMTOR5-AS1 gene (r2  = 0.93, p < 0.0001) expression levels. Based on the area under curve, the increase of lncRNA LAMTOR5-AS1 expression level with a sensitivity of 64.52% and specificity of 65.52% was considered in CRC patients. CONCLUSIONS: We propose that miR20a-5p is inversely related to long non-coding RNA (lncRNA) LAMTOR5-AS, such that it may be involved in the regulation of TGFBR2 expression level in CRC patients.

Evaluation of the histopathologic status of rectal adenocarcinoma and its regional lymph nodes after neoadjuvant therapy, and its relation to the duration of disease-free survival.

INTRODUCTION: Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor. MATERIALS AND METHODS: During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed. RESULTS: Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions). CONCLUSION: In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.

Promising results for hypospadias repair using alloderm® (Regen): A randomized controlled trial.

INTRODUCTION;: Hypospadias is a congenital disorder of urethra in which meatus is not at its correct place and occurs in 1 of 250 live male birth. Many techniques have been used for the repair of hypospadias and to decrease the incidence of fistula. Alloderm has been recently used for the repair of urologic congenital defects, and reconstructive surgeries, but not used in hypospadias in a randomized controlled trial. Therefore, the aim of this study was to assess the efficacy of Alloderm® (Regen) to reduce fistula rate in hypospadias repair. METHODS & MATERIALS: This was a randomized controlled trial. Sixty patients were divided into two groups, 30 children underwent surgery using Alloderm® (Regen) as the Alloderm group and 30 without using it as controls. In the Alloderm group, 21 underwent primary surgery (12 mid-shaft hypospadias who underwent concurrent chordee correction and urethroplasty, and 9 penoscrotal who underwent 2 stage surgery, chordee was first corrected and then 6 months later TIP was performed), and 9 underwent fistula repair due to previous surgeries. In the control group, 24 patients underwent primary surgery (15 mid-shaft, and 9 penoscrotal) and 6 fistula repair the same as the Alloderm group but without using Alloderm. RESULTS: There was no meaningful difference between the two groups regarding age (P = 0.634). There was no meaningful difference regarding the operation type between the two groups (P = 0.371). There was no meaningful difference regarding the meatal location between the two groups (P = 0.781). There were no significant post-operative complications in the both groups. No bleeding or diverticulum occurred. Recurrence of fistula occurred in one patient in the Alloderm group after fistula repair and in 2 in the control group. Overall, In the Alloderm group, 3 (2 after TIP and 1 after fistula repair) patients and in the control group 8 (6 after TIP, 2 after fistula repair) patients developed fistulas after surgery (10% vs 26.7%). There was a statistically meaningful difference regarding fistula formation between the two groups using Chi-square test (P = 0.014). CONCLUSION: Alloderm® (Regen) can be used for hypospadias and fistula repair with very few complications and good results. Fistula was less probably occurred in the Alloderm group compared to the standard repair of hypospadias.

Problem-based learning as an effective method for teaching theoretical surgery courses to medical students.

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.

Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure: a randomized clinical trial.

OBJECTIVES: The aim of this study is to evaluate the effectiveness and complications associated with combined topical diltiazem cream and botulinum toxin A injection versus partial lateral internal sphincterotomy in chronic anal fissure. DESIGN: This study is a parallel, randomized controlled trial (using the block randomization method). SETTING: This study was performed at a university hospital in Iran. PARTICIPANTS: Ninety-nine patients who had chronic anal fissures were included. INTERVENTION: A total of 99 patients were randomly assigned to 2 groups; the first group received combined topical diltiazem ointment (for 6 weeks) and botulinum toxin A injection (once) (n = 49), and the second group received partial lateral internal sphincterotomy (n = 50). All the patients were followed up for 1 year. MAIN OUTCOME MEASURES: The primary outcomes measured were the healing of the anal fissure and the development of incontinence as the major adverse event during the 1-year follow-up period. RESULTS: The overall healing rate was 65% and 94% in the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups (p < 0.001). The patients in the partial lateral internal sphincterotomy group experienced significantly higher incontinence scores (p = 0.04) according to the Cleveland Clinic Florida-Fecal Incontinence scoring system. In patients who had chronic anal fissure for ≤12 months, no statistical difference was observed in the healing rate between the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups (100% vs 100%). However, in the patients with longer chronic fissures, the healing rate was significantly higher in the partial lateral internal sphincterotomy group (86% [18/21] vs 23% [5/21], p < 0.001). LIMITATIONS: The 1-year follow-up period, subjective definitions of itching, and lack of anorectal manometry examinations and data regarding the effect of each treatment on anal sphincter pressure at rest and contraction are the key limitations of this study. CONCLUSION: Combined botulinum toxin A injection with a topical application of diltiazem could be as effective as partial lateral internal sphincterotomy in the treatment of chronic anal fissure in patients who have chronic anal fissure for ≤12 months. However, in chronic anal fissures of longer duration, partial lateral internal sphincterotomy is associated with a significantly higher cure rate.

Validation of Contrast Enhanced Ultrasound Technique to Wire Localization of Sentinel Lymph Node in Patients with Early Breast Cancer.

Axillary staging is one of the primary steps in management of Breast cancer patients. Current standard methods including blue dye and radicolloid have limitations and disadvantages. In this study, the feasibility of visualization of lymph node pathways and localization of SLN with the help of CEUS was assessed. 50 patients with early breast cancer diagnosis underwent CEUS and wire localization, methylenblue dye, and isotope scan methods for SLN detection. The pathology findings of the wired SLN were compared with those obtained from, methylenblue dye, and isotope scan methods. Lymph node wiring was successfully performed in 48 patients.Radio-isotope technique detected SLN in all 50 patients while blue-dye succeeded in 48. Sensitivity of CEUS to detect SLN compared with radio-isotope and blue dye methods was 96 % and 100 %, respectively. Considering costs and facilities required to perform radio-isotope technique and complications of blue dye we may accept CEUS with the help of micro-bubble contrasts as a viable alternative. However, more studies with larger sample volumes, using various drugs, and including non-selective population are warranted to better clarify feasibility and accuracy of this technique in comparison with current methods.

Firework-related injuries in Tehran's Persian Wednesday Eve Festival (Chaharshanbe Soori).

BACKGROUND: Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). OBJECTIVES: This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. METHODS: This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. RESULTS: There were 197 patients enrolled in the study with a mean age of 20.94 ± 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. CONCLUSION: The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities.

Efficacy of pre-hospital care in trauma patients in Iran.

OBJECTIVES: Pre-hospital care plays a vital role in the management of trauma patients. The present study was designed to evaluate the efficacy of the pre-hospital care performed by the Tehran Emergency Medical Service (EMS) in trauma patients. METHODS: The prospective study was performed on trauma patients referred to the emergency department of a teaching hospital by the Tehran EMS from September 2004 until 2005. Considering the lack of scientific observation-based protocols on pre-hospital care, certain protocols were developed based on the available up-to-date protocols in the emergency medicine text books and were used as the gold standard for comparing the provided care by EMSs. RESULTS: The effectiveness of pre-hospital care performed by Tehran emergency technicians, compatible with the patients' condition, was evaluated in 994 patients. Wound bandaging and haemostasis were done correctly in 80% of the indicated cases. Splint was applied correctly in 50% of patients in need for such a device, whereas collar and spinal bed were not performed in 80% of the indicated cases. CONCLUSIONS: Tehran's EMS is not capable of providing trauma patients with effective and accurate pre-hospital care, indicating that major changes are needed to improve this.

Helicobacter pylori infection and postoperative nausea and vomiting.

BACKGROUND/AIMS: The aim of this study was to identify factors most relevant to postoperative nausea and vomiting (PONV) and determine the association of Helicobacter pylori with PONV. METHODOLOGY: A cross-sectional analytic survey was conducted on 127 elective patients who underwent general and urological surgery at Sina Hospital in Tehran between March 2005 and March 2006. Related factors considered to have a possible effect on the prevalence of PONV events were evaluated by using a special questionnaire and serological laboratory test of H. pylori. Data was analyzed using t test and chi2 test and logistic regression analysis for comparing the variables. RESULTS: Prevalence of PONV was 54.7% in patients having H. pylori infection. There was no relationship between H. pylori infection and PONV (p>0.05). Prior history of PONV was a significant risk factor for increasing the prevalence of PONV (p<0.05). Also, history of PONV beside female gender, overweighting/obesity and operation type (urologic surgery) could increase the severity of PONV (p<0.05). But, administration of opioids could decrease the severity of PONV (p<0.05). CONCLUSIONS: It was found that PONV had a high prevalence among patients undergoing urologic and general surgery. H. pylori infection cannot affect the prevalence of PONV. More surveys are needed to develop effective protocols for preventing this common and unpleasant problem.

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This study was conducted to evaluate the safety of laparoscopic cholecystectomy (LC) during pregnancy. Patients who underwent LC were selected from several hospital databases, only six were performed during pregnancy. In this series, one of the two patients who had LC in the first trimester underwent elective termination of pregnancy while the other one gave birth to a term child normally. Half of the four who had the second trimester LC had normal deliveries at term whereas for the other two cesarean section was performed. None of our patients underwent LC in the third trimester. The findings of the present study suggest LC to be a safe procedure performed during the first and second trimester of pregnancy.