Journal of

---

 

Torsion of the gallbladder is a relatively rare surgical disease which mimics acute cholecystitis' symptoms that usually would not be respondable to medical therapies. The torsion would mostly be diagnosed intra-operatively. Cholecystectomy is the treatment of choice. In general in our centre, General Surgery department, Imam Reza hospital, Mashhad, Iran, since 1986 over 14000 cholecystectomies have been performed and 3 cases with an underlying cause of gallbladder torsion are documented. The relative literatures reviewed so then the presentation, paraclinical findings, and the treatment of gallbladder volvulus are discussed. Gallbladder volvulus: Review of the literature and report of three cases.

 

---

Inguinal mass is a common clinical finding or even symptom in childhood while the most common diagnosis is inguinal hernia that may proceed with prompt surgical but there are a vast variety of different entities that may manifest as an inguinal mass and in some instances, surgical approach is not indicated or may need further preoperative assessments to determine a correct therapeutic plan. In this article, we discuss about an example of unusual case of extrarenal Wilms tumor in inguinal region which was presented as an inguinal mass and also review differential diagnosis for childhood inguinal mass.

---

 

Nasogastric tube (NG) insertion is a usual technique in any neonatal intensive care unit. This procedure is undertaken for the children who are in need of invasive care. Sometimes, the insertion of nasogastric tube in infants with esophagus friable anatomy tissues may have some dangerous side effect, but such problems are not very common. Esophageal perforation is a rare but known complication of these procedures. In this study, we present the case of an infant with esophageal perforation. This infant was diagnosed incidentally on X-rays. This problem is usually associated with critically ill patients in the NICU.

 

---

 

Rhabdomyomata are probably the most common tumors that occur very rarely during infancy. In this paper, we report the case of a 49-day-old infant who was diagnosed by echocardiography examination with left ventricle outflow tract (LVOT) obstruction caused by rhabdomyoma. The infant underwent surgical approach, and her mass was shaved. Finally, she was discharged from hospital in good general condition. Six-month follow-up after the operation did not show any obstruction.

 

---

Valvular heart lesions have deleterious effects on hemodynamics in parturients during pregnancy. Cesarean section with an opioid-based general anesthesia is used to alleviate the adverse effects. We described a case of a 28-year-old primigravida at 37 weeks’ gestation with a diagnosis of severe mitral regurgitation, tricuspid regurgitation, and pulmonary hypertension in active labor. Cesarean section under general anesthesia using remifentanil was planned to provide a stable anesthesia and analgesia to minimize hemodynamic changes during surgery. The patient maintained reasonable hemodynamics during surgery. The neonate required transient ventilatory support with bag and mask until she obtained spontaneous respiration. We suggest that remifentanil is a reliable opioid that can produce stable hemodynamic conditions with transient neonatal respiratory depression during cesarean section under general anesthesia in a parturient with severe valvular heart disease and pulmonary hypertension.

---

 

 

---

Pterygium is characterized by an elastic degeneration of the conjunctiva that extends across the limbos and invades the cornea. The recurrence rate is varied from 25-80% after primary closure to 6% with free conjunctival and Iimbal grafts. Several adjunctive therapies have been investigated for recurrent pte¬rygium. This article presents a 52-year-old athletic man who was seen for evaluation of a recurrent lesion in his right eye and treated with topical administration of IFN-α-2b (Intron A, Schering Plough, Kenilworth, NJ), 1 million units/mL 4 times a day as eye drops.

---

Root fractures are defined as fractures involving dentine, cementum, and pulpal and supportive tissues. They comprise about 0.5–7% of all dental injuries. Horizontal root fractures are commonly observed in the maxillary anterior region and 75% of these fractures occur in the maxillary central incisors. Case report: This case report is about a 26-year-old male referred to the endodontic department of Zahedan dental school 3 days after motorcycle accident. Radiographic examination shows a horizontally root fracture of the right mandibular central incisor in the apical third. Initially, the coronal fragment was repositioned and this was radiographically confirmed. Then, the stabilization splint was applied and remained for 50 days. Two weeks splinting which radiographic examination showed the lesion adjacent to the fracture line, the two visit endodontic treatment of the coronal portion was started and the root canal was obturated with gutta percha points. Conclusion: One-year follow-up examination revealed the clinical and radiographic signs of healing with hard tissue repair of the fracture line.

---

Aortic coarctation is a rare but dangerous condition. Presence of aortic dissection in addition to coarctation is significantly rarer and more life-threatening. Here, we present a case of acute inferior MI due to aortic dissection complicating a native aortic coarctation. A 17-year-old boy was admitted to our emergency department due to severe chest pain and loss of consciousness. His electrocardiogram showed ST elevations in Inferior leads proposing an inferior MI. Further evaluations revealed that the patient had been suffering from an underling aortic coarctation complicated by an acute aortic dissection. For every young person with symptoms of acute coronary syndrome, aortic dissection should be considered as a potentially fatal differential diagnosis. Coexistence of aortic coarctation, as an underling and exacerbating factor, should be assessed using appropriate imaging modalities whenever suspected.

---

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder that manifests with hemolytic anemia, thrombosis, and peripheral blood cytopenias.Acute abdominal pain is one of the PNH clinical manifestations due to venous thrombosis of intra-abdominal sites including hepatic, portal, mesenteric, and splenic veins.Eculizumaband allogeneic bone marrow transplantation (BMT) arethe only widely effective therapies for these patients.

We report a case of PNH disorder which presented with abdominal pain and mild tenderness. Abdominal X ray and sonography revealed intra-peritonealfree fluid and air. At laparotomy, an ischemic segment of jejunum with stricture and perforationwith mesenteric venous thrombosis were found. The patient also had a history of hepatic vein thrombosis two years before.

---

Pancoast tumor accounts for 3%-5% of all non-small cell lung carcinomas. This tumor has a distinct clinical presentation through local invasion and the resulting clinical entity called Pancoast syndrome. This syndrome includes severe shoulder pain, arm pain, and Horner’s syndrome andatrophy of forearm and hand muscles. The differential diagnosis of arm and shoulder pain is extensive. Thoracic outlet syndrome and cervical disk disease are commonly mistaken for the Pancoast syndrome in the early clinical course. Diagnosis of Pancoast tumor is often late, and misdiagnosis is a common problem that can affect the prognosis. Therefore, Pancoast tumor should always be considered in differential diagnosis of radicular pain of the upper extremity. We report a case of 55-year-old man who was admitted with right side severe pain in the back of the neck, shoulder and arm with numbness and tingling sensation in the medial aspect of the forearm and 4th and 5th fingers. These symptoms had initiated from 17 months ago, and the patient was treated for cervical discopathy and frozen shoulder.

---

Despite all the diagnosis and treatment processes of pulmonary thromboembolism (PTE), it is still associated with a high rate of mortality. We describe a massive PTE case of a 73-year-old woman with unusual clinical manifestations.

---

Thrombotic events are very unusual in neonatal period. This congenital anomaly may be caused by certain risk factors such as polycythemia, perinatal asphyxia, septicemia, maternal diabetes, dehydration, and low cardiac output, or it may occur upon catheterization of central lines. A 20-day-old neonate was referred to our ward with primary signs of hypertrophic cardiomyopathy (HCMP). Echocardiography and CT-angiography were performed to find stenosis or no stenosis of aortic valve, which showed a great mass into the ascending aorta. This mass was resected and removed successfully and thereafter the aortic arch was repaired. There was no prothrombic disorder in his family history.

---

A hydatid cyst is a zoonotic infection caused by the larval forms of mostly the Echinococcus granulosus. In humans, the most common site of cyst development is the liver (60%), followed by the lungs (20%), and much less commonly in other organs such as kidney, spleen, brain, and other soft tissues. The localization of cysts in muscles and subcutaneous is very rare. We report a case of 38-year-old female patient with a cystic shoulder mass turning out to be hydatid cyst on surgical exploration.

However, especially in non-endemic regions, the most diagnostic tool for an unusual presentation is the awareness of the physician. Surgical excision is the main modality of treatment. Also, complementary investigation to rule out other organs’ involvement is necessary. During surgical interventions, all precautions antiscolicidal solutions along with meticulous surgical techniques go a long way in the prevention of recurrence of this disease.

---

Torsades de pointes is a rare but potentially lethal arrhythmia which mainly occurs in the setting of a prolonged QT interval. ECG is a reliable tool to detect such abnormalities, routinely taken from all patients over 40 who undergo surgery.

We describe the case of a 35-year-old woman with torsades de points arrhythmia after hysterectomy surgery. Most likely, our patients had long QT syndrome which has not already been detected.

Surgery can elicit both acquired and unknown congenital long QT syndrome. Preoperative ECG is recommended even for people under 40 years to detect unknown congenital long QT syndrome.

---

Falling from height is an urban phenomenon and shows an important form of blunt trauma. We report an 18-year-old man who fell from 6 m height onto vertical steel rods in an under construction building. He went under surgery to remove two foreign bodies and was discharged on the 2^nd day after surgery in good conditions. The objective of this report is to provide a definitive baseline to improve the incidence rate of fall from height. It is better to consult with key stakeholders in the workplace to gain a view on the key issues relating to fall from height. Similarly, it is good to use the available measurements in order to control and prevent those at risk.

---

Hand metastasis accounts for approximately 0.1 percent of all metastatic osseous malignancies. The lung, breast and kidney are the most common primary sources of these metastatic lesions.A rare case of retroperitoneal alveolar soft part sarcoma metastasizing to the distal phalanx of the second finger of the right hand is presented here. The patient underwent complete DIP amputation of the affected finger and was referred to oncologist for further therapeutic workups. Acrometastases run a poor prognosis; thus, palliative treatment is in the patient’s best interest.

---

Leeches are segmented worms belonging to Phylum Annelida and make up the subclass Hirudinea. Leeches have been historically used in medicine to suck blood from patients. Ocular infestation with leech is rare, moreover it is often misdiagnosed. In this report, we describe 2 patients with continuous bright ocular bleeding after swimming in a pool, and pseudo iris prolapse in a child after trauma with a wooden piece who immediately washed his face in a stream. Ocular leech infestation must be ruled out in children with a history of contamination or swimming in rural pool or streams.

---

The case is a 2-year-old previously healthy girl with coincidental penetrating eye and brain injury. A metal rod was inserted into the skull through the upper border of the right globe. After admission and diagnostic and surgical approaches, the rod was removed under general anesthesia, and no brain hematoma or ocular and significant periocular injuries were detected. No neurologic and ophthalmologic signs and symptoms were observed during hospitalization, and follow-up brain CT was normal.

---

Acutepancreatitis can infrequently be a life-threatening complication of hypertriglyceridemia. Rarely, hypertriglyceridemia can originate from an inborn genetic error in lipoproteins metabolism. This condition can be manifested by very high serum triglyceride levels (>1000 mg/dl) and a more severe and lethal form of pancreatitis. Here, we present a case of acute pancreatic which was found out to be a complication of an undiagnosed familial hypertriglyceridemia who died in spite of receiving conventional care and treatment. Focus is on the importance of considering infrequent etiologies of acute pancreatitis and application of more effective treatments.