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A Hadadi, M. Rasoolinejad, S. Davoudi, M. Nikdel, M. Rasteh ,
Volume 64, Issue 5 (1 2006)
Volume 64, Issue 5 (1 2006)
Abstract
Background: Pulmonary TB is still the most common form of the tuberculosis in HIV infected patients with different presentations according to the degree of immunosuppression. The aim of this study was to investigate the impact of HIV infection on the clinical, laboratory and radiological presentation of tuberculosis.
Methods: We compared 80 HIV negative pulmonary TB patients with 40 HIV positive pulmonary TB patients during 1999-2005 in a teaching hospital of Tehran University of Medical Sciences, Iran.
Results: Tuberculosis was more common in men in both groups. The mean age of HIV positive patients was lower than HIV negatives (35.95+/-10.4 versus 46.95+/-20.39, P =0.002). Weight loss and chronic cough were significantly more frequent in HIV negative patients (76.3% vs. 45% p<0.001 and 93.8% vs. 80%, P<0.05 respectively), whereas fatigue were more prominent in HIV positives (45% vs. 21.3%, P< 0.001). Cavitations and infiltrations were reported in the CXR of HIV/TB patients less than HIV negative patients (OR=0.21, 95% CI: 0.05-0.97, P= 0.01 and OR=0.27%, 95% CI: 0.09-0.75%, P =0.02 respectively). Primary involvement pattern was observed more than secondary involvement in HIV/TB group (OR=3.95, 95% CI: 1.73-9.03, P =0.001). The laboratory findings in HIV/TB patients were as follows: more negative PPD skin (75% vs. 50%) tests, higher ESR (86.5% vs. 63.7%), lower mean Hb (10.6 vs. 12.4) and lower mean leukocyte (6545 vs. 9195) and lymphocyte count (1281 vs. 1838). In all of the above mentioned findings the differences between two groups were significant. Fourthy Seven% of patients had Lymphocyte count less than 1200 which means they were in AIDS stage.
Conclusion: Immune system suppression in HIV can alter the clinical, laboratory and radiological features of tuberculosis. It is crucial to consider tuberculosis in differential diagnosis of every HIV patients with respiratory symptoms.
Mansoureh Baradaran, Mohammd Ashraf Azimi , Rasoul Nikdel, Seyed Hassan Seyed Sharifi ,
Volume 81, Issue 6 (September 2023)
Volume 81, Issue 6 (September 2023)
Abstract
Background: Splenic artery aneurysm is seen in less than 0.1% of the population. Aneurysm of the splenic artery is more common in pregnant women. One of the life-threatening complications of splenic artery aneurysm is the spontaneous rupture of the aneurysm, which causes hemorrhagic shock. This complication is more common in pregnant women than other people in the society and has more mortality and morbidity. In this study, a pregnant patient with spontaneous rupture of splenic artery aneurysm is reported.
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Case Presentation: The patient is an 18-year-old woman, 20 weeks pregnant, who came to the Emergency department of Bentolhoda Hospital in Bojnurd with diffuse sudden onset of abdominal pain in the September of 2023. On examination, the patient's vital signs were unstable, which was due to the presence of hemorrhagic shock. In the examination of the patient's abdomen, or generalized tenderness and rebound tenderness? was evident, suggesting peritonitis. According to the ultrasound report, abundant free fluid and fluid containing blood was drained from the abdomen under ultrasound guidance. The patient underwent surgery with the diagnosis of hemorrhagic shock with a midline incision of the abdomen above and below the umbilicus. In the performed surgery, evidence of splenic artery aneurysm rupture was evident. For the patient, ligature and resection of splenic vessels (artery and vein) and splenectomy were performed. After surgery and stabilization of the patient's condition, fetal health ultrasound was performed, and the fetus had no heartbeat. Therefore, medical induction of abortion was performed, and after 48 hours, the fetus was completely expelled, and then mother was transferred to the ward. And four days after the surgery, she was discharged with general improvement. No remarkable adverse effects were observed after surgery.
Conclusion: One of the rare diseases is splenic artery aneurysm, which is difficult to diagnose due to its asymptomatic rupture and high mortality rate. |
Mohammad Ashraf Azimi , Rasul Nikdel, Seyed Hassan Seyed Sharifi ,
Volume 82, Issue 2 (May 2024)
Volume 82, Issue 2 (May 2024)
Abstract
Background: Cardiopulmonary resuscitation (CPR) is a potentially life-saving treatment for cardiac arrest but puts the subject at risk for iatrogenic skeletal and soft tissue injuries including the liver. In this study, an elderly patient with grade 5 liver rupture after cardiopulmonary resuscitation following laparotomy is reported.
| Case Presentation: A 76-year-old female patient with diffuse abdominal pain that started a week ago and worsened since 2 days ago in the winter of 2024, referred to the emergency room of Imam Ali Bojnurd Hospital. In the examination, the patient met the criteria for shock. Abdominal examination revealed peritonitis. After initial resuscitation and stabilization of the patient's condition, an X-ray was performed for the patient. According to the Standing chest x-ray, pneumoperitoneum report, the patient underwent surgery with midline incision. In the performed surgery, evidence of gangrene and perforated was evident in a part of the small intestine, and The patient is a candidate for resection of the gangrenous and perforated intestinal segment, and then the two proximal and distal ends of the resected area were removed as an ileostomy from the right side of the abdomen. At the end of surgery, before closing the abdominal wall, the patient suffered a cardiac arrest, and CPR was started for the patient in operation room. After starting the chest massage, the patient suffered a grade 5 liver tear, the bleeding of the liver was stopped by packing with four Large Abdominal pads and CPR continued for 45 min, but unfortunately the patient died. Conclusion: One of the rare complications of cardiopulmonary resuscitation and chest massage is visceral damage, including liver rupture. Considering that its symptoms are similar to cardiac arrest, it is difficult to diagnose in case of rupture and has a high mortality rate. According to the reports of liver and visceral damage after CPR, some studies have recommended the use of Focused Assessment with Sonography for Trauma (FAST) to detect visceral damage after CPR. |
Reihane Chegini , Seyed Hasan Seyed Sharifi , Rasul Nikdel ,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: Benign tumors of the gastrointestinal tract with a muscular origin are typically found in the esophagus, stomach, or small intestine, and rarely in the large intestine. Approximately 3% of all gastrointestinal leiomyomas occur in the large intestine, primarily in the descending colon and sigmoid colon. These lesions are usually asymptomatic and are often discovered during endoscopic procedures.
Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.
Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.
Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.
Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.
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Hadi Khorsand Zak, Seyed Hasan Seyed Sharifi , Yaser Abbasi , Rasul Nikdel,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Intestinal lymphangiomatosis is a rare benign disorder of the gastrointestinal tract characterized by abnormal proliferation and dilatation of lymphatic channels within the intestinal wall and mesentery. It accounts for less than 1% of gastrointestinal tumors and predominantly affects the small intestine, particularly in pediatric patients. Clinical manifestations vary widely depending on the size, location, and extent of the lesions, ranging from asymptomatic presentations to acute complications. Due to its rarity and nonspecific features, early diagnosis is often difficult. Imaging modalities, especially ultrasonography, computed tomography, and magnetic resonance imaging, are crucial for initial evaluation and preoperative planning.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
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