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Comparison of hemorrhoidectomy complications in elderly and non-elderly patients: a retrospective longitudinal study
Kimia Shirbandi, Ramin Azhough, Hosein Shiri ,
Volume 83, Issue 8 (November 2025)
Abstract
Background: Since multiple factors contribute to the occurrence of postoperative complications and these risk factors are generally more prevalent among elderly individuals compared to younger patients this study was conducted to compare the complications of hemorrhoidectomy between elderly and non-elderly patients.
Methods: For each patient, a data collection form was completed, including demographic characteristics (age, sex, body mass index, ASA class, and comorbidities), as well as laboratory and disease-related information. Postoperative complications assessed were bleeding, anal fissure, rectal stenosis, anal pain, hemorrhoid recurrence, reoperation, postoperative infection, pruritus, and urinary tract infection.
Results: The findings indicated that the lymphocyte-to-monocyte ratio LMR Lymphocite to Monocye Ratio) was associated with a reduced incidence of complications, whereas both the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein CRP (c_reactive protein) levels were associated with an increased incidence of complications. Furthermore, hemorrhoid grade, disease duration, number of hemorrhoidal nodules, preoperative pain severity, and chronic preoperative pain were all significantly associated with a higher likelihood of postoperative complications in elderly patients.
Conclusion: This study demonstrates that several factors including hematologic ratios (LMR, NLR), CRP (c_reactive protein) levels, hemorrhoid grade, disease duration, number of hemorrhoidal nodules, preoperative pain severity, and chronic preoperative pain are significantly associated with the occurrence of postoperative complications following hemorrhoidectomy in elderly patients.

 

Addressing concurrent hypoglycemia and thrombocytopenia in a neonate: a case report
Amir Naddaf, Vafa Ghorban Sabbagh , Ghazaleh Rasti, Raheleh Moradi, Mobina Taghva Nakhjiri ,
Volume 83, Issue 8 (November 2025)
Abstract
Background: Neonatal hypoglycemia is a common metabolic disturbance during the first days of life, particularly in infants with risk factors such as prematurity, perinatal stress, intrauterine growth restriction, or maternal diabetes. Early onset thrombocytopenia within the first 72 hours is often attributed to placental insufficiency and reduced platelet production, whereas persistent hypoglycemia beyond this period may indicate sepsis, necrotizing enterocolitis, or hyperinsulinemic states. Given that perinatal stress and asphyxia can predispose to both hypoglycemia and thrombocytopenia, simultaneous presentation of these conditions may complicate diagnosis and management. This case report describes a neonate with persistent hypoglycemia and thrombocytopenia unresponsive to standard therapies, ultimately attributed to transient hyperinsulinism.
Case Presentation: This case was managed and documented at Valiasr Hospital, Tehran University of Medical Sciences, in April 2023. A late preterm female infant born at 36+2 weeks via emergency cesarean section for intrauterine growth restriction and fetal distress presented with hypotonia and hypoglycemia (38 mg/dL) at 15 hours of life. Despite intravenous dextrose infusion up to 13 mg/kg/min, recurrent hypoglycemia persisted. Concurrently, severe thrombocytopenia (26,000/µL) was noted, unresponsive to platelet transfusion and intravenous immunoglobulin. Maternal platelet count was normal, excluding autoimmune etiologies. On day six, a glucagon stimulation test demonstrated a rise in glucose from 44 to 78 mg/dL, confirming hyperinsulinemic hypoglycemia. Laboratory evaluation revealed elevated insulin levels with absent ketones. Glucagon infusion was initiated, followed by diazoxide therapy (15 mg/kg/day) beginning on day ten. After two doses, glucose levels stabilized above 50 mg/dL, allowing gradual reduction of intravenous fluids. Remarkably, platelet counts normalized within five days of diazoxide initiation. Diazoxide was tapered and discontinued by day 27, and the infant was discharged on day 31 with stable glucose levels and normal platelet counts.
Conclusion: This case highlights the coexistence of transient hyperinsulinemic hypoglycemia and thrombocytopenia in a neonate, both of which responded to diazoxide therapy. The temporal relationship suggests a potential modulatory effect of insulin or diazoxide on platelet dynamics. Further clinical and mechanistic studies are needed to clarify this association.

 

Correction of severe kyphosis in a patient with high pelvic incidence: a case report
Mohsen Nabiouni, Ahmad Ghorbanpour Barforoshi , Ali Tavakoli Pirzaman ,
Volume 83, Issue 8 (November 2025)
Abstract
Background: Severe spinal kyphosis, particularly in patients with sagittal imbalance and high Pelvic incidence (PI), represents one of the most challenging conditions in spinal surgery. This deformity is commonly associated with chronic pain, functional limitation, and a decreased quality of life.
Case Presentation: A 66 year old woman presented with progressively worsening radicular pain, gait impairment, early fatigue while standing, and a severe kyphotic deformity with marked sagittal imbalance. Her history was significant for an instrumented lumbar fusion from L3 to S1 performed in March 2023, complicated by persistent right foot drop, followed approximately five weeks later by rehospitalization for herpetic encephalitis; concurrent imaging demonstrated inflammatory changes at the L5-S1 disc space suspicious for discitis, although CT guided biopsy cultures were negative. Her medical comorbidities included type 2 diabetes mellitus and prior coronary artery bypass grafting. Radiographic and spinopelvic analysis revealed adjacent segment disease at L2-L3 and severe sagittal malalignment with a pelvic incidence of 88°, lumbar lordosis of 30°, and sagittal vertical axis of 25 cm. Given the significant PI-LL mismatch and progressive postural collapse, revision deformity surgery was indicated. The patient underwent a Smith-Petersen osteotomy at L5-S1 with long segment posterior fixation from T11 to S2, including iliac screw fixation, between August and September 2025. Postoperatively, lumbar lordosis improved to 45°, pelvic incidence decreased to 65°, and global sagittal alignment was restored, resulting in marked pain relief, improved standing tolerance, correction of spinal balance, and stable neurological status during recovery.
Conclusion: Postoperatively, significant improvement in sagittal balance was achieved, with LL increasing to 45° and PI decreasing to 65°, leading to marked functional recovery and pain relief. This case powerfully demonstrates the correlation between a high Pelvic incidence (PI) and prior surgical failure. It serves as an important didactic example in understanding the biomechanical drivers of sagittal deformity, emphasizing the optimization of safer, corrective surgical techniques for high-risk, complex patients to ensure durable global alignment.

 

Use of propofol before umbilical cord clamping in cesarean surgery un-der spinal anesthesia in mothers with nausea and anxiety: a letter to ed-itor
Mohammad Hossein Shakeri Goki , Reza Payami , Farzaneh Jadidi, Fateme Javaheri, Mobin Ghanipour, Melika Omidvar ,
Volume 83, Issue 8 (November 2025)
Abstract

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