Babol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Pioneering Modern Surgery in Iran - The Legacy of Professor Yahya Adl15716173300310.22088/caspjs.2025.2081247.1045ENPouyaTayebiDepartment of Vascular and Endovascular Surgery, Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.0000-0002-6923-0221Journal Article20251218Professor Yahya Adl, widely regarded as the father of modern surgery in Iran, was a pioneering figure in the development of surgical practices and medical education in the country. He was the first to perform complex surgeries, including cardiac, thoracic, and spinal procedures, in the country. His innovative approaches led to the creation of specialized surgical departments, including the first trauma unit and blood bank in Iran. Throughout his career, he was dedicated to training the next generation of surgeons, establishing "Maktab-e-Adl" (the Adl School) which became a prominent educational center. Professor Adl’s influence extended beyond the operating room, as he also advocated for public health reforms and served the underprivileged. His legacy as an educator, innovator, and humanitarian remains deeply embedded in the fabric of Iranian medical history.https://www.caspjs.com/article_733003_64320a4c8b2efb34d88c34a0693e8b4f.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Managing Balloon Disruption During Below-the-Knee Angioplasty: Successful Endovascular Retrieval16217073303510.22088/caspjs.2025.2081359.1046ENPouyaTayebiDepartment of Vascular and Endovascular Surgery, Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.0000-0002-6923-0221Journal Article20251219Peripheral arterial disease is a prevalent vascular condition that frequently necessitates endovascular interventions, such as balloon angioplasty, for revascularization. This case report presents the management of a 65-year-old male patient with critical limb ischemia and a chronic total occlusion in the anterior tibial artery. The procedure encountered a challenging complication when a monorail balloon used for crossing the lesion in the anterior tibial artery disrupted from mid-shaft, leaving a long segment inside the vessel. However, this complication was effectively resolved using an endovascular approach. The clinical implication of this case highlights the importance of adaptability and skill in managing unexpected complications during endovascular procedures. Proper guidewire management and careful balloon handling are essential in preventing additional damage to the vessel and achieving a successful outcome.https://www.caspjs.com/article_733035_4d11eb3039ac46e9feb8eb8f6a43e919.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Cardiac Arrest Patients Exhibiting Awareness During Resuscitation: A Systematic Review of CPR-Induced Consciousness (CPRIC) in Adults17117673462610.22088/caspjs.2026.2084520.1050ENGhodsiehEsmaeilnezhadClinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran0000-0002-2505-844XSanaHajiaghaeiClinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran0009-0001-6451-4890Mir SaeidRamezaniClinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran0000-0001-9330-0851Journal Article20260218Background: CPR-induced consciousness (CPRIC) is a phenomenon where patients regain cerebral perfusion sufficient to exhibit signs of life during active resuscitation. While documented in medical cardiac arrest, its prevalence and management in traumatic cardiac arrest (TCA) remain poorly defined.<br>Objectives: To systematically review the manifestations, management, and outcomes of CPRIC in adult patients following traumatic cardiac arrest.<br>Methods: A PRISMA-compliant systematic review was conducted across PubMed, Scopus, Web of Science, and Cochrane Library from inception to January 2026. Studies involving adult TCA patients exhibiting CPRIC were included.<br>Results: Eleven studies (case reports and small case series) met inclusion criteria, representing 14 unique cases. Manifestations ranged from purposeful limb movement and eye-opening to combativeness and verbalization. Interventions often involved the ad-hoc administration of ketamine or benzodiazepines. Survival to discharge was higher in this subgroup than general TCA cohorts, though heterogeneity was high.<br>Conclusion: CPRIC in trauma presents unique clinical and ethical challenges. Standardized protocols for sedation during TCA are urgently required to prevent patient distress and provider interference.https://www.caspjs.com/article_734626_1d65e029122e354d5bbc7c2f9dfc00c6.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Non-watertight Dural Closure for Supratentorial Craniotomy Seems Enough: Technical Consideration17718373322410.22088/caspjs.2026.2080759.1044ENRamtinPourahmadFaculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran0000-0003-1107-047XHamedAhamdianDepartment of Neurosurgery, Babol University of Medical Sciences, Babol, Iran0000-0002-2251-1069MahdiHabibitabarStudent Research Committee, Babol University of Medical Sciences, Babol, IranEbrahimHejazianDepartment of Neurosurgery, Babol University of Medical Sciences, Babol, Iran0000-0001-7383-4485Journal Article20251213Watertight dural closure (WTDC) is traditionally regarded as standard practice in craniotomy, although postoperative cerebrospinal fluid (CSF) may still leak through small gaps and predispose to extradural fluid collection, incisional fistula, infection, and wound dehiscence. Non-watertight dural closure (non-WTDC), defined as low-tension approximation of the dural edges without pursuit of complete closure, may mitigate pressure gradients across the dura and reduce these complications in included cases. We applied a standardized non-WTDC technique in 40 consecutive patients undergoing elective supratentorial craniotomy for a range of supratentorial lesions, including tumors, arachnoid cysts, ruptured and unruptured aneurysms, subdural hematoma, and arteriovenous malformations. Three patients developed postoperative CSF collections; one resolved with conservative management, and two were successfully treated with secondary conversion to WTDC. No patient developed an incisional CSF fistula, meningitis, or wound breakdown. In this early experience, non-WTDC after supratentorial craniotomy appeared sufficient and safe in appropriately included patients and may offer practical advantages by simplifying dural reconstruction and obviating the need for dural grafts or sealants during the primary closure.https://www.caspjs.com/article_733224_117fe2704e17fa79008cd9be58469d9d.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Prevalence of Cancer-Related Biomarkers in Breast Cancer Patients in Northern Iran18419073168810.22088/caspjs.2025.2073646.1040ENSeyed RezaModarresDepartment of Surgery, Azad University of Mazandaran, Sari, Iran0009-0004-8708-1057AliTaghaviDepartment of Surgery, Sari Branch, Islamic Azad University, Sari, Iran0009-0005-5921-5086AmirhosseinFouladi TarghiDepartment of Surgery, Sari Branch, Islamic Azad University, Sari, Iran0009-0000-0639-2752Journal Article20251009Background:<br><br>Breast cancer is the most common cancer in women and a leading cause of mortality. Molecular biomarkers such as estrogen receptors (ER), progesterone receptors (PR), HER2, and Ki-67 play a crucial role in assessing prognosis and guiding treatment. The prevalence and patterns of these biomarkers can vary across different populations, making it important to study their relevance in local settings.<br><br>Methodology:<br><br>This descriptive cross-sectional study was conducted on 117 breast cancer patients from healthcare centers in Babol, Northern Iran, between 2019 and 2023. Data were collected from medical records and a researcher-developed questionnaire, which included demographic information, tumor characteristics, and molecular biomarker status (ER, PR, HER2, and Ki-67). Statistical analysis involved descriptive methods such as frequency distributions, percentages, and means.<br><br>Results:<br><br>The average age of the patients was 56.23 years (SD = 10.88). The biomarker expression showed that 66.7% of patients were ER-positive, 59% were PR-positive, 23.1% were HER2-positive, and 66.7% were Ki-67 positive. No distant metastasis (M1) was reported, with 100% of patients in M0 status. The analysis indicated that ER and PR positivity increased with age, while Ki-67 positivity was higher in younger patients. Tumor stage and lymph node involvement were associated with higher Ki-67 expression.<br><br>Conclusion:<br><br>This study highlights the significant role of molecular biomarkers in breast cancer prognosis. The findings suggest that older patients tend to have hormone-sensitive tumors, while younger patients show higher tumor proliferative activity. Biomarkers like ER, PR, HER2, and Ki-67 can be used for personalized treatment strategies, potentially improving patient outcomes.https://www.caspjs.com/article_731688_ae19e12128a9b2a92c86b2b82ee23955.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201The Effect of Epidural Injection of Triamcinolone and Bupivacaine on Pain and Functional Disability in Patients with Lumbar Spinal Stenosis, A Quasi-Experimental Study19119873260110.22088/caspjs.2025.2078187.1043ENHadiEbrahimiDepartment of Neurosurgery, Babol University of Medical Sciences, Babol, Iran0000-0003-4540-1759Seyed HosseinHamidiDepartment of Anesthesiology, Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.0000-0002-7542-7936DavoodVaeziStudent Research Committee, Babol University of Medical Sciences, Babol, Iran0009-0004-5016-0982YahyaJavadianMobility Impairment Research Center, Rehabilitation Faculty, Babol University of Medical Sciences, Babol, Iran0000-0002-0152-9729Journal Article20251118Background:Lumbar canal stenosis is an important factor in causing pain and functional disability.The study aimed to investigate the effect of epidural injection of triamcinolone and bupivacaine on pain intensity and functional disability in patients with lumbar spinal stenosis.<br>Methods:With a quasi-experimental study,100 patients with symptoms of lumbar spinal stenosis were randomly selected and inered the study.The interlaminar injection consisted of 8cc of a 2500mg solution of bupivacaine and the addition of 2cc (80 mg) of triamcinolone to the solution, which in a total of 10cc of this mixture was injected into the epidural space.Variables were measured pre-and one month post-injection.The primary outcome was pain intensity,and secondary outcomes were functional disability according to sex and age.A p-value of less than 0.05% was considered a significant level.<br>Results:The mean pain intensity and functional disability one month after injection in all patients were decreased and were statistically significant(p<0.001).The mean pain intensity decreased in men and women after injection inter groups (p<0.001) but didn’t reach a significant level between groups(mean deference=1.43±0.52,p=0.59).The mean functional disability decreased in men and women after injection in per group(p<0.001) but mean difference between them didn’t reach a significant level(mean deference=2.11±1.50,p=0.95).Although the mean reduction in pain intensity and functional disability was more in younger people, there was no significant difference between the different ages and sexes. <br>Conclusions: It seems that epidural injection of triamcinolone and bupivacaine solution can be used as a safe and effective drug to reduce pain intensity and functional disability in patients with lumbar spinal canal stenosis.https://www.caspjs.com/article_732601_42ea26761f42dedc870b8ec7cbf2e124.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Comparison of Hemodynamic Responses of Pregabalin plus Fentanyl and Fentanyl Alone After Endotracheal Intubation in Lumbar Spine Surgery: A Double-Blind, Randomized Clinical Trial19920873330510.22088/caspjs.2026.2068401.1029ENParvizAmriProfessor of Critical Care Medicine, Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran.0000-0003-2648-9820RezaRojaiiResident of Anesthesia, Student research committee, Babol University of medical sciences, Babol, Iran.ShahramSeyfiClinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran0000-0002-6554-3693HodaShirafkanAssistant Professor, Department of Biostatistics, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.0000-0002-5682-1153Journal Article20250809Introduction: Endotracheal intubation increases heart rate and blood pressure. The aim of this study is to compare the hemodynamic response of pregabalin plus fentanyl and fentanyl alone after tracheal intubation in lumbar spine surgery.<br><br>Methods: In this double-blind clinical trial study, 80 patients, 20-65 years old, who were candidates for spine surgery were randomly divided into two equal groups. Before tracheal intubation, the first group was prescribed fentanyl (F) and the second group received pregabalin and fentanyl (P). Variables including systolic blood pressure, diastolic blood pressure, heart rate at different times, and the average pain score after surgery based on the Numerical Rating Scale were recorded.<br><br>Results: The average age in the F group was 46.98 ± 8.91 and in the P group was 45.43 ± 12.49 years. The mean systolic blood pressure at different times in the two groups, analyzed by repeated measures ANOVA, showed a significant group effect (P=0.001). The average diastolic blood pressure at different times in the two groups also showed a significant group effect (P=0.002). The average heart rate one minute after induction of anesthesia was significantly higher in the F group than in the P group (P<0.001). The average pain score was 5.88 in the F group and 4.98 in the P group, which did not show a significant difference (P=0.313).<br><br>Conclusion: The results of this study showed that the hemodynamic changes after tracheal intubation in the pregabalin plus fentanyl group were less than in the fentanyl alone group.https://www.caspjs.com/article_733305_0ce6ff8aba2ba3f80861d386cb03da9b.pdfBabol University of Medical SciencesCaspian Journal of Surgery3115-90871420251201Postoperative Outcomes of Arteriovenous Fistula Creation in Pediatric Hemodialysis Patients20921373303410.22088/caspjs.2025.2072355.1037ENSeyed MostafaMortazaviVascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran.0009-0009-2078-0036Mohammad MahdiKamyarVascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran.0000-0003-0504-0549Gholam HoseinKazemzadehVascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran.0000-0003-1778-8060JamalJalili ShahriVascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran.0000-0001-8768-1563FatemehSadeghipour KermaniVascular and Endovascular Surgery Research Center, Mashhad University of Medical Science, Mashhad, Iran.0000-0003-1822-3408GhazalehHajiaghajaniOrthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-0174-7021Journal Article20250929Background: Due to the limited availability of kidney transplants and the increasing number of patients on waiting lists, dialysis remains the primary treatment for children with end-stage renal disease. Vascular access, particularly arteriovenous fistula (AVF), is a key method for long-term hemodialysis, but it presents challenges in pediatric patients under 10 years old. This study aimed to evaluate the outcomes and complications of AVF creation in this age group.<br><br>Methods: This retrospective, cross-sectional study was conducted on 25 children with ESRD who underwent AVF creation between 2016 and 2020. Data collected included demographics, type of AVF created, and complications associated with the procedure. Descriptive statistical analysis was performed on the data.<br><br>Results: Among the 25 children, 9 (36%) experienced complications related to AVF. The most common complications were AVF immaturity (6 patients, 24%), thrombosis (2 patients, 8%), aneurysm (2 patients, 8%), hemorrhage (1 patient, 4%), and no infections at the surgical site. During follow-up, 4 patients (16%) received kidney transplants, and 5 patients (20%) required additional interventions to create new hemodialysis access.<br><br>Conclusion: The results of this study show that complications related to AVF creation are more frequent in children under 10 compared to adults. Therefore, the use of alternative access methods, such as central venous catheters, to preserve the veins for future fistula creation and to avoid severe complications in children is recommended.https://www.caspjs.com/article_733034_f85eaa1915abd50888008c5292daf6ae.pdf