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Peritonitis and pneumoperitoneum due to emphysematous cholecystitis: a case report
Seyed Hassan Seyed Sharifi , Ghodratollah Maddah, Mohammad Etezadpour,
Volume 79, Issue 6 (September 2021)
Abstract
Background: Emphysematous cholecystitis is a rare variant of acute cholecystitis with high mortality and morbidity rate. Emphysematous cholecystitis most often occurs in older men and Emphysematous cholecystitis often occurs in patients with chronic diseases such as diabetes and vascular disease. The combination of emphysematous cholecystitis and pneumoperitoneum is even rarer. In this study, we reported a rare case of pneumoperitoneum on plain abdominal X-ray with emphysematous cholecystitis in an 83-year-old woman.
Case Presentation: The patient was 83 years old, lady who had been referred to the emergency department of Ghaem Hospital, Mashhad University of Medical Sciences in April 2019, due to diffuse abdominal pain that had started suddenly 3 days earlier. Pneumoperitoneum, the air in the gallbladder wall and the air encircling the gallbladder were reported in standing and supine abdominal x-rays and standing chest X-rays. At first, the patient was resuscitated and treated with broad-spectrum antibiotics. After initial treatment, the patient underwent open cholecystectomy with a subcostal incision on the right and a diagnosis of emphysematous cholecystitis. After surgery, the patient's general condition improved and she was discharged without mortality and morbidity with oral third-generation Cephalosporin antibiotics. The general condition of the patient after discharge was good in the examinations performed in the clinic of Ghaem Hospital, 1 and 3 months after discharge.
Conclusion: Emphysematous cholecystitis is a rare and severe form of acute cholecystitis that occurs due to the process of arterial ischemia caused by contamination with anaerobic bacteria and the formation of gas in the wall and lumen of the gallbladder. Emphysematous cholecystitis is more severe than other types of acute cholecystitis and has higher mortality and morbidity and is life-threatening. Due to the acute and progressive course of emphysematous cholecystitis, correct and timely diagnosis and treatment are important.

A case report peritonitis and Retropneumoperitoneum after procedure for prolapsed hemorrhoid: a case report
Seyed Hassan Seyed Sharifi , Alireza Tavassoli, Mohammad Etezadpour,
Volume 80, Issue 1 (April 2022)
Abstract
Background: Hemorrhoids are one of the most common perianal diseases. They have several surgical and non-surgical treatment methods. Among surgical procedures, Stapler hemorrhoidopexy method has recently gained widespread acceptance. Hemorrhoidopexy with a circular stapler usually has a series of common and mild complications and a few rare and life-threatening complications such as rectal perforation, which requires emergency surgery. In this article, a case of rectal perforation in a middle-aged man following hemorrhoidopexy with Circular Stapler in a Procedure for Prolapse and Hemorrhoids (PPH) is reported that he underwent emergency surgery.
Case Presentation: The patient is a 43-year-old man who presented to the emergency department of Mashhad Ghaem Hospital in June 2020 due to acute general abdominal pain especially in the lower abdomen that started 3 days ago the patient has a history of hemorrhoidopexy with a Circular Stapler in a Procedure for Prolapse and Hemorrhoids (PPH) 5 days ago. The patient had a fever at the time of referral, other vital signs were normal. During the examination, the patient had tenderness and rebound tenderness, especially in the lower abdomen. Hydropneumoperitoneum or Retropneumoperitoneum or Hydroretropneumoperitoneum was reported on the abdomen and pelvic Computed Tomography (CT) scan with and without oral and intravenous contrast. The patient was diagnosed with intraperitoneal rectal perforation. He was then diagnosed with intraperitoneal rectal perforation and treated with intravenous antibiotics and surgery. After surgery, the patient's general condition improved and he was discharged without mortality and morbidity with the good condition after 6 days.
Conclusion: Hemorrhoidopexy with a stapler is more widely accepted than other hemorrhoidectomy methods especially manual methods for prolapse hemorrhoids due to less postoperative pain, shorter hospital stays, and faster return to work. Although this procedure usually has mild side effects that do not require surgery, sometimes life-threatening complications such as rectal perforation may happen, which requires prompt diagnosis and appropriate treatment.

Evaluation of the relationship between axon injury and clinical symptoms in patients with multiple sclerosis using diffusion tensor MRI imaging
Milad Jalilian, Iraj Abedi, Mohammadreza Sharifi,
Volume 80, Issue 2 (May 2022)
Abstract

Background: Magnetic resonance imaging (MRI) is a non-invasive imaging technology that shows detailed anatomical and pathological images. It is often used for disease detection, diagnosis, and treatment monitoring, in particular with neurodegenerative diseases, such as Multiple sclerosis (MS), Alzheimer's and amyotrophic lateral sclerosis. However, conventional MRI provides only qualitative information and cannot distinguish between myelin and axon destruction. One of the new methods in early detection for axonal injury is the DTI sequence, which can be used to observe and quantify the various dimensions of these plaques, including the direction of diffusion and average diffusion. In other words, in DTI, quantitative data from the image helps to estimate the physiological and pathophysiological information of plaques in the brain. This study aimed to investigate the relationship between DTI parameters including FA, MD, RD, AD, axon injury and severity of clinical symptoms in patients with MS.
Methods: This is a cross-sectional control case study that was performed in Isfahan Milad Hospital from December 2020 to August 2021. DTI imaging was performed on 41 patients with MS and 41 normal individuals, and DTI indices including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in different areas of the brain were evaluated. A visual analog scale (VAS) was used to assess the severity of clinical symptoms in patients. The relationship between DTI indices and the severity of clinical symptoms and axon injury was analyzed by the Kolmogorov-Smirnov test.

Results: Correlation analysis showed that there is a significant correlation between DTI sequence parameters and the VAS visual analog scale (P˂0.05) and according to the positive values of the correlation coefficient, there was a positive and significant relationship between VAS and the mentioned parameters and with increasing parameters. The DTI sequence of the Visual Analog Scale (VAS) was significantly increased.

Conclusion: Indicators obtained from the DTI sequence can be used in the prognosis of the disease and the estimation of the severity of clinical symptoms during the patients' involvement.


Antioxidant effects of adipose derived stem cells conditioned media against high glucose-induced injuries in cultured of C28I2 chondrocytes
Sedigheh Safari, Akram Eidi, Mehrnaz Mehrabani, Mohammad Javad Fatemi , Ali Mohammad Sharifi ,
Volume 81, Issue 1 (April 2023)
Abstract
Background: Osteoarthritis (OA) is the most common form of arthritis characterized by progressive loss of articular cartilage, causing pain and loss of articular function. High glucose is a crucial inflammatory factor playing a pivotal role in the pathogenesis of OA that induces ROS production. Since most of the current therapies for OA are short-term benefits, hence, there is high demand for finding novel therapeutic agents for OA treatment. Recent studies have demonstrated that mesenchymal stem cells secrete important therapeutic factors that protect chondrocytes. In the current study, we investigated the protective potential of Adipose-derived stem cell conditioned medium (CM-ADSC) as an alternative to cell therapy in high glucose-mediated oxidative stress in C28I2 human chondrocytes.
Methods: This experimental study was performed in the Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran from May 2018 to August 2020. Adipose-derived stem cells were cultured until they reached 90% confluence then washed with PBS and cultured in a FBS-free medium for 48 hours. The conditioned medium was collected and centrifuged. The protective effect of the concentration of conditioned medium on high glucose (75mM)-induced oxidative stress in C28I2 cell viability was evaluated by WST-1 assay. Total RNA was isolated from the treated and untreated cells with TRIzol reagent. The mRNA expression of antioxidant enzymes including, glutathione S-transferase-P1 (GSTP1), catalase (CAT), and superoxide dismutase1 (SOD1) was evaluated by reverse transcription-polymerase chain reaction in treatment and non-treatment groups.
Results: Adipose-derived stem cell conditioned medium pretreatment remarkably protected C28I2 cells against high glucose. The expression of mRNA of CAT, GSTP1, and SOD1 significantly increased following treatment with the conditioned medium (50%) for 24 hours in high glucose-exposed cells as compared to the control.
Conclusion: Present study indicates that the Adipose-derived stem cell conditioned medium can reduce oxidative stress. It seems that the conditioned medium may protect cartilage in the progression of osteoarthritis.

Spontaneous rupture of accessory spleen 16 years after splenectomy: a case report
Seyed Hassan Seyed Sharifi , Mansoureh Baradaran,
Volume 81, Issue 2 (May 2023)
Abstract
Background: In most patients, the accessory spleen (AS) is small in size. However, in patients who have undergone splenectomy, AS may hypertrophy. This manuscript presents a rare case of spontaneous AS rupture nearly two decades after a prior splenectomy due to trauma. After searching multiple databases, only a few similar cases have been reported to date. In any acute abdominal patient with a history of previous splenectomy who presents with a mass in the anatomical location of the spleen, along with evidence of hematoma and free abdominal fluid on imaging, the possibility of AS rupture should be considered.
Case Presentation: In February 2022, a 36-year-old man who had undergone splenectomy due to trauma 16 years ago was referred to the emergency department at Imam Ali Hospital in Bojnord. He complained of sudden onset of severe abdominal pain, preferably in the upper region of the abdomen. The patient denied having any recent issues. Based on the patient's history and examination, at perforated stomach ulcer and pancreatitis were initially suspected. However, except for leukocytosis, no other abnormalities were observed in the laboratory tests. Ultrasound revealed a low-echo mass-like lesion in the anatomical location of the spleen. Another low-echo mass-like lesion, indicating a hematoma with abundant free fluid in the abdomen and pelvis, was also observed near the aforementioned mass. CT scan confirmed these findings. Open surgical and re splenectomy procedures were performed, and the diagnosis of spontaneous AS rupture was made based on clinical examination and imaging findings.
Conclusion: In any patient with a history of previous splenectomy who presents to the emergency room with diffuse and acute abdominal pain, even without recent trauma, if a mass-like lesion is observed in the anatomically suspicious location of the spleen in the left subphrenic space, along with other evidence of rupture such as hematoma/laceration and free fluid in the abdominal cavity, accessory spleen rupture should be considered as the main differential diagnosis.

Spontaneous rupture of splenic artery aneurysm in a pregnant woman: a case report
Mansoureh Baradaran, Mohammd Ashraf Azimi , Rasoul Nikdel, Seyed Hassan Seyed Sharifi ,
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.
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.

Arteriovenous malformation of the small intestine causing lower gastrointestinal bleeding: a case report
Narjes Mohammadzadeh , Seyed Rasoul Mirsharifi , Alireza Abkhoo , Soroush Kohansal, Mohammad Ashouri ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Lower gastrointestinal bleeding, a symptom that can become the cause of a life-threatening condition, has a 33 per 100,000 prevalence. The origin of lower gastrointestinal bleeding in most cases is the small intestine, colon, or anorectal parts. Surgical consultation in patients with gastrointestinal bleeding is one of the most necessary measures so that the patient can be treated at the appropriate stage with a greater chance of success before reaching shock. In the case of uncontrolled gastrointestinal bleeding, surgery is recommended as soon as possible when endoscopic and radiological treatments are not possible or effective.
Case Presentation: In this article, we present a case of uncontrolled lower gastrointestinal bleeding in a 50-year-old patient who was admitted to Imam Khomeini Hospital in Tehran on December 15, 2021. Despite performing appropriate paraclinic measures such as sonography, endoscopy, and colonoscopy the gastrointestinal bleeding origin was not determined. On the other hand, our investigations showed that she had liver cirrhosis. Due to the instability of the patient's condition due to continued lower gastrointestinal bleeding, the medical team decided to perform surgery. The surgeon noticed that the origin of the bleeding was a vascular entanglement at the small intestine-navel junction, and the procedure involved segmental excision of the small intestine.
 Conclusion: In cirrhotic patients, lower gastrointestinal bleeding is an emergency condition, and if the source of the bleeding is not accessible via endoscopy or colonoscopy, diagnosing and treatment become extremely difficult. Computed tomography angiography and subsequent surgery are effective approaches for diagnosing and treating these conditions. When lower gastrointestinal bleeding is uncontrolled, exploratory laparotomy should be considered. Due to the unknown origin of bleeding, exploratory laparotomy may not be successful, so using endoscopy during surgery can help to diagnose the location of the lesion in these cases; However, in some cases despite all measures, the source of bleeding may not be determined, in these case the rate of rebleeding after surgery will be high.

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