Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Perioperative Management of Patients on Direct Oral Anticoagulants (DOACs): Challenges and Strategies 104 107 729989 10.22088/caspjs.2025.2073432.1039 EN Pouya Tayebi Department of Vascular and Endovascular Surgery, Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0002-6923-0221 Journal Article 2025 10 03 The growing use of DOACs presents significant challenges in the perioperative management of surgical patients. Effective management requires careful consideration of the timing of drug discontinuation, the use of reversal agents in case of bleeding, and ensuring safe reinitiation of anticoagulation post-surgery. Collaboration among the surgical team, anesthesiologists, and specialists is vital for optimizing patient safety and minimizing risks associated with both bleeding and thromboembolism. As DOACs continue to play a central role in anticoagulation therapy, ensuring proper management during the perioperative period is essential for positive patient outcomes.

https://www.caspjs.com/article_729989_46006d44905f278cbb2b116d65ba3988.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Spindle Cell Lipoma of the Right Inguinal Canal Mimicking an Inguinal Hernia: A Case Report with Long-Term Radiologic Resolution Post-Surgery 108 112 731131 10.22088/caspjs.2025.2069361.1032 EN Hamid Shafi Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran 0000-0002-3344-923X Ghodsieh Kamrani Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran 0000-0001-6553-4693 Shiva Goharshahi Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran 0000-0001-8639-7114 Zahra Shafi Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran 0009-0003-8946-4011 Mohammad Akbari Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran 0000-0002-9406-8940 Reza Baaslroudi Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran Student Research Committee, Babol University of Medical Sciences, Babol, Iran 0009-0003-5395-7877 Journal Article 2026 02 14 Background: Spindle cell lipoma (SCL) is a rare benign neoplasm, most commonly exhibiting in the posterior neck and back of men in middle age. Inguinal canal involvement is considered rare and can clinically mimic hernias or malignancy, leading to diagnostic and management difficulties. Case Presentation: In the current paper we report the case of a 68-year-old man who presented with a progressively enlarging, non-deducible right inguinal mass extending into the scrotum over a period of 2–3 months, in contribution with lower abdominal discomfort and urinary symptoms. Initial evaluations, including imaging and laboratory tests, suggested a soft-tissue lesion without any evidence of hernia or lymphadenopathy. The patient underwent surgical excision approximately two years prior to this report. Histopathology and immunohistochemistry confirmed a diagnosis of low-grade spindle cell lipoma. Follow-up imaging, including CT, pelvic MRI, and ultrasound, showed no residual lesion or recurrence, and the patient remained clinically stable. Conclusion: This case represents an unusual location of spindle cell lipoma with clinical presentation mimicking inguinal hernia, managed successfully with surgical excision. Long-term follow-up confirmed radiologic resolution, underscoring the benign nature of the lesion and the importance of accurate histopathological diagnosis.

https://www.caspjs.com/article_731131_b66388e227f274395bf7717cb80ea8fe.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Lumbar Spine Ligament Augmentation Technique to Prevent Proximal Junctional Kyphosis: A Short Communication 113 116 730089 10.22088/caspjs.2025.2061891.1017 EN Ebrahim Hejazian Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0003-4540-1759 Masoud Yahyazadeh Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0003-4540-1759 Arman Ferasat Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0003-4540-1759 Hadi Ebrahimi Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0003-4540-1759 Morteza Sharifzadeh Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0003-4540-1759 Journal Article 2025 10 06 Abstract Background: Proximal junctional kyphosis (PJK) is a frequent complication following lumbar spine fusion. It may lead to loss of alignment, neurological symptoms, and the need for revision surgery. Various techniques have been proposed to reduce the risk of PJK, including ligament augmentation. Methods: We applied a simplified wire-based posterior ligament augmentation technique in 12 patients undergoing posterior lumbar fusion for degenerative conditions. A steel wire was passed through or over the spinous process of the vertebra one level above the upper instrumented vertebra (UIV+1) and secured to the construct to reinforce the transition zone. Patients were followed clinically and radiographically for 6 to 12 months. Results: No patient developed radiographic evidence of PJK, defined as a ≥10° increase in the UIV–UIV+2 angle. All fusion constructs remained stable, with no rod fractures, screw loosening, or need for revision surgery observed during the follow-up period. Conclusions: This wire-based augmentation technique is simple, low-cost, and technically feasible in routine lumbar fusion cases. While preliminary, the results suggest a potential role in preventing PJK. Further studies are warranted to validate its long-term effectiveness.

https://www.caspjs.com/article_730089_7c7da70e6454aadbf4d57bbecb82db3a.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Advancements and Applications of Artificial Intelligence in Breast Cancer Diagnosis and Treatment: A Comprehensive Review 117 120 730866 10.22088/caspjs.2025.2075030.1041 EN Adeleh Fakourijouybari Faculty of Medicine, Brunel Medical School, London, UK 0009-0000-7555-2617 Journal Article 2025 10 18 Breast cancer remains the most prevalent malignancy among women worldwide and a leading cause of cancer-related death. Recent advances in artificial intelligence (AI) have transformed approaches to detection, diagnosis, prognosis, and management of breast cancer. AI techniques, particularly deep learning and radiomics, enable earlier detection and more precise risk stratification by analyzing complex imaging and pathological data. This narrative review summarizes current applications, advances, and limitations of AI in breast cancer care, highlighting its potential to enhance personalized medicine.

https://www.caspjs.com/article_730866_1140c7dd1639ae3f10787d7f0c839b43.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Risk Factors of Amputation in Patients With Diabetic Foot: A Comprehensive Narrative Review 121 132 728835 10.22088/caspjs.2025.2059789.1007 EN Zeinab Mohseni Afshar Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Mazandaran, Iran 0000-0002-1085-374X Arefeh Babazadeh Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Mazandaran, Iran 0000-0002-1362-7203 Soheil Ebrahimpour Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Mazandaran, Iran 0000-0003-3204-0448 Rahmat Jokar Department of Orthopedic and Trauma Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Iran 0000-0001-5517-3804 Mohammad Barary Student Research Committee, Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0001-8733-9370 Journal Article 2025 06 07 Abstract Background: Amputation remains a significant complication of diabetic foot disease, associated with substantial morbidity and mortality. Objective: To synthesize available evidence on demographic, metabolic, vascular, infectious, and ulcer-related factors associated with amputation in adults with diabetic foot ulcers, using a transparent narrative framework augmented by systematic-narrative elements. Methods: This is a narrative review conducted within a transparent narrative framework (no meta-analysis). We searched four databases (2000–2024): PubMed/MEDLINE, Embase, Scopus, and Cochrane Library for studies involving adults with diabetic foot ulcers reporting associations with amputation. Conference abstracts and non-indexed sources were excluded. Study selection, data extraction, and quality appraisal were performed with predefined criteria by independent reviewers. Data were organized into modifiable versus non-modifiable factors; where available. Results: Included studies identified modifiable factors (e.g., glycemic control, infection, osteomyelitis, PAD severity, wound care adequacy) and non-modifiable factors (e.g., age, diabetes duration, comorbidity burden) associated with amputation risk. Conclusions: Targeted multidisciplinary strategies addressing modifiable factors may reduce amputation risk. High-quality prospective studies are needed to quantify associations and inform guidelines. diabetic patients.

https://www.caspjs.com/article_728835_4d0c5c100933d07c02511eb2e954af20.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Application of Botulinum Toxin A for Prevention of Scar Formation and Improve the Cosmetic Results in Thyroidectomy and Lateral Neck Dissection Incision Site 133 141 729742 10.22088/caspjs.2025.2069525.1034 EN Elmira Khodabakhsh Clinical Research Development Unit of Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, I.R. Iran 0000-0002-0429-5251 Seyed Muhammad Mehdi Ghaffari Hamedani Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran 0000-0003-4667-9824 Amirhossein Jamali Department of Operating Room, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran 0009-0007-5145-4386 Bahman Barimani Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran 0000-0002-3344-923X Abbas Alipour Community Medicine Department, Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran 0000-0003-0781-3728 Ghasem Rahmatpour Rokni Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 0000-0002-5608-1167 Journal Article 2025 08 23 Background and Objective: The aim of this study was to investigate the effect of botulinum toxin injection in preventing or reducing hypertrophic scars in the incision area for individuals. Materials and Methods: After completion of thyroidectomy surgery, half of the incision length was marked, and botulinum toxin was injected 1 cm away from the incision edges at a dose of 7.5 u/cm2. Normal saline injection was performed as a control for the other half of the incision length. Patients were photographed at 1 and 3 months post-surgery, and scars were evaluated for aesthetic parameters using the VSS system. Results: Fourteen female participants with a mean age of 35.5 ± 7.08 years took part in this study. 11 individuals (78.6%) underwent thyroidectomy surgery. 2 patients (14.3%) underwent modified radical neck dissection (MRND), and 1 patient underwent lateral neck dissection surgery. The mean score for the area injected with botulinum toxin at 1 and 3 months follow-up was 1 and 0 respectively, while for the area injected with saline, it was 2 and 1 at 1 and 3 months (p = 0.001). In both saline and botulinum toxin groups, the score decreased significantly after 3 months (P<0.001). Conclusion: Injection of botulinum toxin at a specific dose leads to satisfactory results in terms of aesthetic parameters, showing statistically significant differences.

https://www.caspjs.com/article_729742_c7b110ada8c1632b916f235b1c58cf2e.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Comparison of Clinical Outcomes of Dynamic Compression Plate Versus Locked Intramedullary Nailing in the Treatment of Femoral Shaft Fractures: A Retrospective Cohort Study 142 150 730860 10.22088/caspjs.2025.2069453.1033 EN Atefe Charkazi Student Committee Research, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 0009-0004-3929-7988 Mani Falsafi Department of Orthopedic Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0003-4292-0211 Ali Bijani Social Determinats of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 0000-0003-2233-8726 Mehdi Tavassoli Department of Orthopedic Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0001-7790-9237 Journal Article 2025 08 22 Background: Femoral shaft fractures are among the most challenging orthopedic injuries, often necessitating surgical fixation. Although dynamic compression plating (DCP) and locked intramedullary nailing (IMN) are both standard options, their comparative outcomes in closed, non-comminuted fractures remain debated. This study aimed to compare the clinical outcomes and complications of IMN versus DCP fixation in adult patients with mid-shaft femoral fractures. Methods: This retrospective cohort study included 40 adults with closed, non-comminuted mid-shaft femoral fractures treated at Shahid Beheshti Hospital, Babol, Iran (2022–2024). Twenty patients underwent IMN and 20 underwent DCP fixation. Demographic, intraoperative, and postoperative data—including infection, nonunion, fixation failure, intraoperative blood loss, hospitalization duration, and knee range of motion (ROM)—were extracted from medical records. Outcome definitions followed CDC and AO standards. Results: Patients in the IMN group were significantly older than those in the DCP group (32.55 ± 20.74 vs. 19.90 ± 15.96 years; p = 0.037). Operative time was longer for IMN (191.25 ± 29.95 min) compared with DCP (151.00 ± 31.23 min; p < 0.001). No statistically significant differences were found between groups in infection (p = 0.465), nonunion (p = 1.000), fixation failure (p = 1.000), ROM (p = 0.300), blood loss (p = 0.428), or hospitalization duration (p = 0.832). Conclusion: Both IMN and DCP provided similar short-term outcomes for closed femoral shaft fractures. However, due to the small sample and retrospective design, these findings are preliminary. Larger, prospective randomized trials are needed to confirm the results and guide optimal surgical decision-making.

https://www.caspjs.com/article_730860_904fa4d3e34a785dd29e3d817c4d1171.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 3 2025 09 01 Comparison of the Effect of Intravenous Regional Anesthesia with Single-Cuff Forearm and Upper Arm Tourniquets on Pain in Patients Undergoing Elective Hand Surgery 151 156 730112 10.22088/caspjs.2025.2067262.1027 EN Nadia Banihashem Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0003-4706-9147 Masoume Mosavi Tabarkani Student Research committee, Babol University of Medical Sciences, Babol, Iran. 0000-0001-9330-0851 Shahram Seyfi Department of Anesthesiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. 0000-0002-6554-3693 Ebrahim Alijanpour Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0001-6832-5774 Journal Article 2025 07 28 Background: Intravenous regional anesthesia(IVRA), also known as a Bier block, is an effective anesthetic technique for upper limb surgery. This study aimed to compare the efficacy of IVRA using a single-cuff tourniquet on the forearm versus a single-cuff tourniquet on the upper arm in patients undergoing elective hand surgery. Methods: In this randomized controlled trial, sixty patients(ASA I-II) scheduled for elective upper limb surgery were randomly allocated into two groups of 30 people. The intervention group received IVRA with a single-cuff forearm tourniquet and 100mg lidocaine injection. The control group received IVRA with a single-cuff upper arm tourniquet and 200mg lidocaine injection. Pain intensity at the surgical and tourniquet sites was assessed using the Visual Analog Scale(VAS) at baseline and intraoperatively. Results: A total of 60 patients the onset of analgesia was significantly faster in the Upper Arm Group(6.17±2.52 vs. 7.67±2.25minutes,p=0.019). Surgical site pain was significantly higher in the Upper Arm Group at 90minutes (1.3±0.54 vs. 1.07±0.25,p=0.028) and immediately after surgery (1.3±0.48 vs. 1.1±0.3,p=0.03). Tourniquet pain increased over time in both groups (p<0.0001), but there was no significant difference between the groups (p=0.814). There were no significant differences in patient characteristics, surgery duration, or type of anesthesia between the two groups (p>0.05). Conclusion: For procedures lasting up to 30minutes,IVRA with a single-cuff forearm tourniquet and 100mg lidocaine provides analgesia comparable to the upper arm technique with 200mg lidocaine. Considering the side effect of lidocaine, a single-cuff forearm tourniquet technique may be preferred method due to its lower used of lidocaine.

https://www.caspjs.com/article_730112_f0f8e1a9e60744c382d1d170f4cfc97a.pdf