General surgery
Maryam Yousefi; Fariba Yarandi; Elham Shirali; Shahab Rajabzadeh; Pershang Nazemi
Articles in Press, Accepted Manuscript, Available Online from 07 February 2024
Abstract
We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable ...
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We reported a 55-year-old woman with a history of recent surgery presented to the emergency room with complaints of erythema and foul-smelling discharge from her surgical incision site. Upon examination in the emergency room, the surgical incision site was promptly opened, thoroughly cleaned with a sizable amount of sterile normal saline, and evaluated and cultures were sent for microbiological and histological evaluation. The patient was promptly initiated on a combination antibiotic regimen, including ceftazidime, levofloxacin, metronidazole, and vancomycin, under the guidance of the infectious disease team. Fungal mycelium was found in the smear of wound discharge in recent microbiological exam. In response to the suspected fungal infection, fluconasol was promptly added to the treatment regimen to combat the fungal pathogen. According to result of microbiological cultures, non-albicans candida and its resistance to fluconasol, caspofungin was substituted. Patient's condition dramatically improved with the combined treatment of meropenem and caspofungin. The development of necrotizing fasciitis in this patient's case added a critical layer of complexity to an already challenging clinical scenario. The rapid recognition, aggressive surgical intervention, and targeted antimicrobial therapy collectively played a pivotal role in her successful recovery. This case underscores the importance of vigilance in monitoring postoperative patients, particularly those with risk factors, and highlights the need for a multidisciplinary approach in managing this severe soft tissue infection.
Obstetrics and Gynecology
Behnaz Moradi; Sara Naybandi Atashi; Elham Shirali
Volume 7, Issue 6 , September and October 2022, , Pages 587-588
Abstract
Adnexal masses characterization is a really challenging issue and is essential for appropriate patient management. Ovarian Adnexal Reporting and Data System (O-RADS) is tone excellent standardized lexicons to provide practical uniform terms, definitions and measurements for describing and classifying ...
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Adnexal masses characterization is a really challenging issue and is essential for appropriate patient management. Ovarian Adnexal Reporting and Data System (O-RADS) is tone excellent standardized lexicons to provide practical uniform terms, definitions and measurements for describing and classifying ovarian masses.In the first publication of O-RADS system, they noted that cystic lesions with maximum diameter of solid component of ≥7 mm, are at higher risk for malignancy. On the other hand, the number of papillary projections had nearly similar positive LR (2.2). Despite this and inclusion of the number of papillary projections in the final risk stratification system, the maximal size of solid part was not included and no cystic lesion with solid component could be categorized in O-RADS 3 category, and size of papillary projection make no change in malignancy risk stratification.In conclusion, we propose that in O-RADS lexicon the use of maximal diameter of solid components (with 7 mm cut off point) along with number of papillary projections is helpful to categorize cystic ovarian mass lesions as auxiliary item for classifying risk of malignancy less than 10% to higher than 50% (O-RADS 3 to ORADS 5).
Obstetrics and Gynecology
Fatemeh Golshahi; Fariba Yarandi; Sara Ramhormozian; Elham Shirali
Volume 7, Issue 2 , September and October 2021, , Pages 121-125
Abstract
With increase in the second-trimester pregnancy termination, debates continue on the most suitable mode of termination. Misoprostol is used as an agent for the medical abortion. Some authors believe that uterine rupture risk as a complication of medical termination is higher in the patients with positive ...
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With increase in the second-trimester pregnancy termination, debates continue on the most suitable mode of termination. Misoprostol is used as an agent for the medical abortion. Some authors believe that uterine rupture risk as a complication of medical termination is higher in the patients with positive cesarean section history while some others have no report of such effect. This complication cannot be predicted and can occur under various circumstances with different misoprostol regimens. Hereby, we reported three cases with positive cesarean section history undergoing second-trimester pregnancy termination due to preterm premature rupture of the membranes (PPROM) who developed uterine rupture with similar misoprostol dosages. Finally, we conclude that more cautions should be undertaken in the setting of PPROM with previous history of cesarean section or gestational age >20 weeks about uterine rupture risk and full recommended misoprostol dose must not be administered to prevent life-threatening events.
Elham Shirali; Fariba Yarandi; Mostafa Safavi; Omid Hemmatian; Marjan Ghaemi
Volume 4, Issue 3 , September and October 2019, , Pages 117-119
Abstract
Background & Objective: Primary vaginal sarcomas are extremely rare and counts about 2-3% of all vaginal malignancies. We report a case with vaginal leiomyosarcoma which was treated by radical hysterectomy.
Case Report: A 46 year old woman from Iraq, referred to Yas Hospital by chief complaint of ...
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Background & Objective: Primary vaginal sarcomas are extremely rare and counts about 2-3% of all vaginal malignancies. We report a case with vaginal leiomyosarcoma which was treated by radical hysterectomy.
Case Report: A 46 year old woman from Iraq, referred to Yas Hospital by chief complaint of post-coital bleeding and a vaginal mass with pathology report of vaginal leiomyosarcoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and partial vaginectomy (2/3 upper of the vagina). She refused to receive chemotherapy after surgery. In 3 years follow up, she did not have any recurrence.
Conclusion: Experiences about vaginal leiomyosarcoma are not sufficient due to rarity of the disease. However, based on review of the literature surgery is still the first choice followed by both chemotherapy and radiotherapy that are preferred based on current reports.
Elham Shirali; Fariba Yarandi; Nadereh Behtash; Omid Hemmatian
Volume 3, Issue 2 , May and June 2018, , Pages 87-91
Abstract
Aims: Cervical cancer is one of the most common cancer in the female since 1990. Neoadjuvant chemotherapy (NACT) uses before surgery, especially in countries with limited radiotherapy facilities. The aim of the present review was to study the effect of NACT before radical surgery in comparison with other ...
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Aims: Cervical cancer is one of the most common cancer in the female since 1990. Neoadjuvant chemotherapy (NACT) uses before surgery, especially in countries with limited radiotherapy facilities. The aim of the present review was to study the effect of NACT before radical surgery in comparison with other treatments and various clinical outcomes.
Information and Methods: This study is a systematic review and includes previous publishes about cervical cancer and effect of NACT before radical surgery. Over 40 previous studies were reviewed, none of them was case report, at least 5 studies were randomized clinical trials and 6 of them were meta-analysis or systematic review.
Findings: NACT before surgery demonstrates advantages to reduce the rate of lymph node metastasis and parametrial infiltration, so improves progression-free survival in patients with pelvic lymph node invasion (Approximately 35% of stage IB2–IIB bulky). NACT also decreases tumor volume and minimizes the need for adjuvant radiotherapy, thus NACT under consideration of quality of life and cost-effectiveness should be recommended. NACT is really effective in decreasing incidence of pathological risk factors.
Conclusion: NACT response associated with the stage of diagnosis, tumor size and pathology of the specimen (Squamous tumor has a better response than a non-squamous tumor). NACT seems to be feasible in the management of stage IB bulky cervical cancer, NACT followed by surgery represent an alternative to primary chemoradiotherapy in young and sexually active patients.
Elham Shirali; Fariba Yarandi; Majid Safavi; Omid Hemmatian
Volume 1, Issue 1 , May and June 2016
Abstract
Introduction: Early diagnosis of endometrial cancer in younger female patients has good prognosis and better survival because of lower stage and lower grade. Endometrial cancer should be diagnosed early at lower stage because of signs and symptoms of patients. We report on a usual case of endometrial ...
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Introduction: Early diagnosis of endometrial cancer in younger female patients has good prognosis and better survival because of lower stage and lower grade. Endometrial cancer should be diagnosed early at lower stage because of signs and symptoms of patients. We report on a usual case of endometrial cancer that was miss diagnosed because she insisted on the protection of her hymen and virginity.
Case Presentation: We report a usual case of endometrial cancer that was miss-diagnosed because the patient insisted on the protection of her hymen and virginity. A 32-year-old virgin female did not permit a general gynecologist for endometrial biopsy or curettage, to protect her hymen and virginity; the patient had stage IV endometrial cancer.
Conclusions: In conclusion, patients with persistent signs and symptoms should be considered for endometrial cancer especially patients with high risk factors: nulliparity, late menopause, obesity, diabetes mellitus, unopposed estrogen therapy, tamoxifen therapy, atypical endometrial hyperplasia, Lynch II syndrome, etc. However, the most important issue for patients with persistent symptoms and risk factors for endometrial cancer in highly religious countries is obtaining a document for the gynecologist that endorses patient virginity.
