Babol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Hemorrhage Management in Blast Injuries: Insights and Implications485072930110.22088/caspjs.2025.2069016.1030ENPouyaTayebiDepartment of Vascular and Endovascular Surgery, Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.0000-0002-6923-0221Journal Article20250815Recent airstrike attacks on civilian populations have once again exposed a critical gap in trauma response: the scientific and tactical management of hemorrhage in mass-casualty events. Hemorrhage remains the leading cause of preventable death in both military and civilian blast injuries. This editorial, reviews eight evidence-based strategies for hemorrhage control in bombing scenarios, emphasizing the urgency of integrating military-grade techniques into civilian surgical and emergency care systems.https://www.caspjs.com/article_729301_0356dd6052d6b34320da2475ef109d39.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Cavernous Hemangioma of Adrenal: A Rare Incidentaloma with Pheochromocytoma Simulation515772759210.22088/caspjs.2025.2063569.1022ENEmadodinMoudiClinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran0000-0002-5151-1981NiushaJamshidiClinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran0009-0001-5871-5696Seyed MohammadhasanHosseiniStudent Research Committee, Babol University of Medical Sciences, Babol, Iran0009-0001-5871-5696KaranMoudiStudent Research Committee, Babol University of Medical Sciences, Babol, Iran0009-0002-3193-5602GhodsiehKamraniClinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran0000-0001-6553-4693Journal Article20250615Cavernous hemangiomas of the adrenal gland are extremely rare benign vascular tumors, accounting for approximately 0.01% of adrenal masses. They are typically discovered incidentally during imaging for other conditions. We report an unusual case of adrenal cavernous hemangioma identified during adrenalectomy surgery. A 60-year-old woman was diagnosed with a left adrenal mass found on a lung CT scan performed due to dyspnea, attributed to bronchiectasis. The imaging revealed a 40 mm adrenal mass with heterogeneous enhancement and calcification. Although adrenal function tests excluded pheochromocytoma, the manipulation of the adrenal gland during surgery unexpectedly triggered a hypertensive crisis. Postoperatively, the patient required intensive monitoring but stabilized and was discharged without the need for antihypertensive medications. Histopathological examination confirmed the diagnosis of cavernous hemangioma. Adrenal cavernous hemangiomas are rare benign tumors typically diagnosed after adrenalectomy by histological examination. Their distinct radiological features on CT scans can be helpful for diagnosis and may prevent unnecessary overtreatment in some cases.https://www.caspjs.com/article_727592_e90396e29c80acb64d8f632452c35a19.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Combined Spinal Anesthesia and Peripheral Nerve Block in a Patient with Severe Aortic Valve Stenosis and Reduced LVEF Undergoing Femur Fracture Repair586472672510.22088/caspjs.2025.2062533.1021ENSedigheHasaniStudent research committee, Babol University of medical sciences, Babol, Iran.0009-0005-8430-7628Seyed HosseinHamidiDepartment of Anesthesiology, Clinical research development unit of Rouhani hospital, Babol University of Medical Sciences, Babol, Iran.0000-0002-7542-7936KouroshJafarkazemiDepartment of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.0000-0002-2142-6970MajidKhalilizadDepartment of Orthopedics, Clinical research development unit of Shahid Beheshti hospital, Babol University of Medical Sciences, Babol, Iran.0000-0002-5711-0492ShaghayeghToluoStudent research committee, Babol University of medical sciences, Babol, Iran.0009-0004-2336-0874Journal Article20250622Patients suffering severe aortic stenosis (AS) who have reduced left ventricular ejection fraction (LVEF) have exceptionally high risk for perioperative complications, like heart failure and hemodynamic collapse. This case report describes the anesthetic management of a 79-year-old male with severe AS (AVA 0.6 cm²), LVEF 30%, and pulmonary hypertension (PAP 40 mmHg) who supposed to undergo right intertrochanteric femur fracture repair. Our challenge was to choose the best anesthesia plan, in which while preserving the hemodynamics, adequate analgesia would be provided for the surgery. We successfully used a combination of spinal anesthesia using low dose bupivacaine and peripheral nerve block to minimize hemodynamic disturbances while ensuring adequate analgesia. This experience shows that the combination of peripheral nerve block and low-dose neuraxial anesthesia can provide the necessary analgesia for lower limb surgery without compromising the patient’s hemodynamics. It can encourage our anesthetic colleagues to accept such patients so that they can receive treatment and return to their normal lives.https://www.caspjs.com/article_726725_9df4fe9eabbecfbe753574b9f78dd24a.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Minimally Invasive Bariatric Surgery: Advancements and Techniques657672552110.22088/caspjs.2025.2062244.1018ENAliAsriMinimally Invasive Surgery Research Center, Iran University
of Medical Sciences, Tehran, Iran0000-0003-2019-8010ShimaRezaei BanaDepartment of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally
Invasive and Bariatric Surgery, Hazrate Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran0009-0004-2454-4157MohsenLotfipourDepartment of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally
Invasive and Bariatric Surgery, Hazrate Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran0009-0001-6325-5380Journal Article20250531Minimally invasive bariatric surgery has become a cornerstone in the treatment of obesity, offering effective weight-loss solutions with fewer complications, shorter recovery times, and reduced hospital stays compared to traditional open surgeries. This review provides an overview of the most commonly used minimally invasive techniques, including Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), Laparoscopic Sleeve Gastrectomy (LSG), Mini Gastric Bypass (OAGB), Laparoscopic Adjustable Gastric Banding (LAGB), and emerging endoscopic procedures such as Endoscopic Sleeve Gastroplasty (ESG) and Intragastric Balloon (IGB) Therapy. Each procedure’s mechanism of action, benefits, challenges, and expected outcomes are discussed, along with the patient selection criteria that help determine the most appropriate approach. The review highlights that minimally invasive approaches significantly reduce operative trauma, hospital stays, and postoperative complications, while also improving obesity-related comorbidities such as type 2 diabetes and hypertension. LRYGB and OAGB combine restrictive and malabsorptive mechanisms, leading to substantial weight loss and metabolic improvements, but require careful long-term nutritional monitoring. LSG, primarily a restrictive procedure, offers a favorable safety profile and is associated with significant appetite reduction due to hormonal changes. The article also discusses the challenges and complications unique to each technique, such as anastomotic leaks, nutritional deficiencies, and bile reflux. Overall, advances in minimally invasive bariatric surgery have expanded treatment options, improved patient outcomes, and set the stage for further innovations in obesity managementhttps://www.caspjs.com/article_725521_1b64d759817d3be1bf8dfd0bd21a1a4e.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Survival and long-term outcome of coronary artery bypass grafting in patients with heart failure and reduced left ventricular ejection fraction778472547410.22088/caspjs.2025.2059341.1002ENRoghayehPourkiaClinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran0000-0002-8013-7888HamidrezaVafaeyClinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran0000-0001-8267-820XSoroushAbediniStudent Research Committee, Babol University of Medical Sciences, Babol, Iran0009-0007-7467-3004HemmatGholiniaCancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran0000-0003-0517-2429SiminMouodiSocial Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran0000-0001-7868-9360Journal Article20250430Background<br><br>Heart failure with reduced left ventricular ejection fraction (HFrEF) is associated with increased mortality and morbidity. This research was carried-out to explore the survival and long-term outcomes of coronary artery bypass grafting (CABG) in patients diagnosed with HFrEF.<br><br>Methods<br><br>This retrospective cohort study was performed with reviewing the hospital databank related to all patients who underwent CABG in the state hospital affiliated to Babol University of Medical Sciences, north of Iran during 2011-2021. Adult patients who had EF lower than 40% were included by census, and followed for the research outcomes. Survival of the participants was considered as the primary outcome; and serious clinical complications were recorded as the secondary outcomes. <br><br>Results<br><br>Totally, 229 patients with HFrEF undergoing CABG were included. Mean age was 64.48±10.92 year; 153 subjects (66.8%) were male. The patients followed after the CABG surgery in a range from 1 to 68 months. Forty-five subjects (19.65%) died, and 184 (80.35%) survived during the study period; and 143 patients (62.45%) had re-admission in the hospital because of cardiac manifestations. Mean and standard error of survival time was 58.37±1.32 (95% CI: 55.78-60.95) months. Multivariable cox-regression analysis revealed the significant effect of age (adjusted HR: 1.288; 95% CI: 1.052-1.576; P=0.014) and LV size (adjusted HR: 58.847; 95% CI: 1.044-3316.247; P=0.048) on mortality of patients with HFrEF undergoing CABG.<br><br>Conclusions<br><br>Given considerable proportion of death and cardiovascular manifestations in people with HFrEF undergoing CABG, more precise and regular care of these patients is emphasized.https://www.caspjs.com/article_725474_ca56715be11da0c6a81d86874acd1a84.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Thrombocytopenia and Its Impact on Bleeding Risk During Chemotherapy Port Placement: A Comparative Study859072792110.22088/caspjs.2025.2064862.1023ENMaryamParsaStudent Research Committee, Babol University of Medical Sciences, Babol University of Medical Sciences, Babol, Iran.0009-0006-3960-6351PouyaTayebiDepartment of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.0000-0002-6923-0221MajidNabipourDepartment of Hematology & Oncology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.0000-0001-6224-5036FatemehFarsianiStudent Research Committee, Babol University of Medical Sciences, Babol University of Medical Sciences, Babol, Iran.0009-0003-7157-8504AliBijaniSocial Determinant of Health Research Center, Babol University of Medical Sciences, Babol, Iran.0000-0003-2233-8726Journal Article20250705Background: Thrombocytopenia, a common condition in cancer patients undergoing chemotherapy, presents significant challenges in medical procedures, particularly in central venous port placement, due to the elevated risk of bleeding.<br><br>Methods: This study involved 100 cancer patients undergoing chemotherapy port placement, divided into two groups: 50 patients with thrombocytopenia (platelet count <150,000/μL) and 50 without. Bleeding complications were assessed and compared between the two groups. Laboratory data, including platelet counts and coagulation parameters, were analyzed, and statistical comparisons were made using chi-square and t-tests.<br><br>Results: The incidence of bleeding complications was significantly higher in the thrombocytopenic group (12%) compared to the non-thrombocytopenic group (2%) (p = 0.050). Hematoma formation was observed in 4% of patients, with a higher occurrence in the thrombocytopenic group (6%) versus the non-thrombocytopenic group (2%), although this difference was not statistically significant (p = 0.307). Ecchymosis occurred in 3% of patients, all in the thrombocytopenic group (p = 0.079). Patients with severe thrombocytopenia (platelet count < 50,000/μL) had a significantly higher risk of active bleeding, with a notable association between platelet count and bleeding (p = 0.034).<br><br>Conclusion: Thrombocytopenic patients, particularly those with severe thrombocytopenia, face an increased risk of bleeding during chemotherapy port placement. Ultrasound-guided techniques, along with preoperative management strategies, can effectively minimize bleeding risks.https://www.caspjs.com/article_727921_81bfe154763ca08c54c4e78db736eb7e.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601Comparative Analysis of Functional Outcomes Following Axial vs. Transverse Pinning in Boxer's Fractures919672837910.22088/caspjs.2025.2059924.1012ENMobinMarzban AbbasabadiStudent Research Committee, Babol University of Medical Sciences, Babol, Iran0009-0001-0845-7924MehdiTavassoliOrthopedic Department, Mobility Impairment Research Center, Shahid Beheshti
Hospital, Babol University of Medical Sciences, Babol, Iran0000-0001-7790-9237MajidKhalilizad DaronkolaiDepartment of Orthopedic, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.0000-0002-5711-0492Journal Article20250612Background:<br><br>Boxer's fractures, common injuries of the hand, often require surgical intervention. This study compares the outcomes of axial and transverse pinning techniques in fifth metacarpal fractures. The primary focus was on evaluating angular deformity in radiographic views and functional recovery, especially considering the needs of manual workers and athletes.<br><br>Methods:<br><br>In a cross-sectional study, 60 patients underwent surgical fixation using either axial or transverse pinning. Functional assessment was done via Total Active Motion (TAM) and the Iranian Quick DASH questionnaire. Radiographic evaluation included angular deformity and complications such as nonunion and malunion.<br><br>Results:<br><br>No significant differences were found between groups regarding TAM scores, Quick DASH results, or radiographic deformities (P > 0.05). Additionally, radiological outcomes for complications such as nonunion and malunion showed no statistically meaningful variation between the two techniques (all P> 0.05).<br><br>Conclusion:<br><br>Axial and transverse pinning methods provide similar functional and radiographic outcomes in Boxer's fractures, making both viable surgical options. Thus, both pinning techniques can be considered effective treatment options for these fractures.https://www.caspjs.com/article_728379_938913897d3475bd789963354dac4efd.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871220250601The Impact of Serum Vitamin D Levels on Pseudoexfoliative Glaucoma Severity: Should It Be Considered Before Surgical Intervention?9710372861210.22088/caspjs.2025.2067855.1028ENKianaHoghoughifardStudent Research Committee, Health Research Center, Babol University of Medical Sciences, Babol, Iran.0009-0000-6577-8655HodaShirafkanSocial determinants of health research center, health research institute, Babol university of medical Sciences, Babol, Iran.0000-0002-5682-1153NourmohammadPanahiDepartment of ophthalmology,Rouhani hospital,Babol university of medical sciences, Babol, Iran0009-0003-0820-7591MohammadRanaeeDepartment of Pathology, Rouhani Hospital, Babol University of Medical Science, Babol, Iran.0000-0002-7583-489XAliMakaremiDepartment
of ophthalmology, Faculty of medicine, Sari branch, Islamic Azad University,
Sari, Iran.0009-0007-1058-896XMasoumehAsgharpourDepartment of Nephrology, Rouhani Hospital of Medical Sciences, Babol, Iran.0000-0002-5504-4612MehrnooshGhasemiDepartment of ophthalmology,Rouhani hospital,Babol University of Medical Science,Babol,Iran0000-0003-4836-3436Journal Article20250805Background: Pseudoexfoliative glaucoma (PXG) is a form of glaucoma with protein deposits causing increased intraocular pressure and optic nerve damage. While pharmacological treatment manages pressure, surgery is often needed in advanced cases. This study explores the relationship between serum vitamin D levels and PXG severity, focusing on its role in disease progression and treatment.<br><br><br><br>Method: A total of 114 patients in Rouhani Hospital's glaucoma clinic, were enrolled in the study, participants were divided into three groups: severe Pseudoexfoliative Glaucoma, mild-to-moderate Pseudoexfoliative Glaucoma, and a control group. We assessed the association between serum vitamin D levels and Pseudoexfoliative Glaucoma severity, considering potential influences of age, sex, and intraocular pressure.<br><br><br><br>Results: Based on our study there are not significant association between serum vitamin D levels and Pseudoexfoliative Glaucoma severity (p = 0.89). Additionally, there are not statistically influence of vitamin D on Pseudoexfoliative Glaucoma severity within subgroups based on age, sex, or intraocular pressure (all p > 0.05). Notably, linear regression analysis identified age (p < 0.001, β = 0.404), female sex (p < 0.001, β = 0.206), and higher intraocular pressure (p < 0.001, β = 0.344) as significant independent factors associated with increased Pseudoexfoliative Glaucoma severity.<br><br><br><br>Conclusion: <br><br>Serum vitamin D levels do not directly impact the severity of pseudoexfoliative glaucoma and the need for surgical intervention. However, factors such as age, sex, and intraocular pressure are critical in determining disease severity, emphasizing their significance in clinical management.https://www.caspjs.com/article_728612_e892c9216aa55ab7337a1081258ccbf5.pdf