https://www.caspjs.com/ Caspian Journal of Surgery en daily 1 Mon, 01 Dec 2025 00:00:00 +0330 Mon, 01 Dec 2025 00:00:00 +0330 https://www.caspjs.com/article_733003.html Professor 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_733035.html Peripheral 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_734626.html Background: 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.Objectives: To systematically review the manifestations, management, and outcomes of CPRIC in adult patients following traumatic cardiac arrest.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.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.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_733224.html Watertight 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_731688.html Background: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.Methodology: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.Results: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.Conclusion: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_732601.html Background: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.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.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. 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_733305.html Introduction: 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.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.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).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_733034.html Background: 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.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.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.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_733798.html Biliary ileus is a rare but notable cause of mechanical intestinal obstruction, often seen in patients with a history of gallbladder disease. This image captures the intraoperative removal of a gallstone that had impacted in the ileum, obstructing the bowel. The case highlights the diagnostic and surgical importance of recognizing biliary ileus in the context of small bowel obstructions. https://www.caspjs.com/article_735168.html Surgical procedures, while crucial for physical healing, often impose substantial psychological stress on patients, impacting recovery and overall well-being. This editorial advocates for a paradigm shift towards integrating mental health support throughout the surgical journey. It highlights the prevalence of perioperative psychological challenges, including preoperative anxiety and postoperative mood disturbances, and their detrimental effects on clinical outcomes. The piece emphasizes the necessity of a multidisciplinary approach, incorporating systematic psychological screening, enhanced patient communication, optimized pain management, and robust postoperative support. By moving beyond a purely biomedical focus, healthcare providers can foster holistic patient recovery, improve satisfaction, and ultimately enhance the effectiveness of surgical interventions. https://www.caspjs.com/article_735314.html Background: Carpal tunnel syndrome (CTS) is one of the most prevalent entrapment neuropathies of the upper extremity. Hydrodissection, a technique guided by ultrasound, has gained increased interest in the last decade for managing entrapment neuropathies. However, the comparison of ultrasound-guided hydrodissection versus open surgery for the treatment of CTS remains challenging due to uncertainty in current findings from limited studies. This trial compared the effects on function and severity of ultrasound-guided hydrodissection with methylprednisolone against open surgery in patients with moderate-to-severe CTS. Methods: In this randomized parallel-group, single-blinded clinical trial, 46 patients with CTS aged 20 to 65 were randomly allocated to either hydrodissection (injection of methylprednisolone, n=23) or open surgery (n=23) group. The functional status and severity scores of the Boston Carpal Tunnel Questionnaire (BCTQ) were the primary outcome and were assessed at baseline and one and three months after each intervention. Results: 44 patients, with a mean age of 48±10.3, successfully completed the study. Adjusting for baseline outcomes, the mixed model ANCOVA did not reveal significant Group*Time interactions for either severity (F=1.006; P=0.330; ηp2 =0.056) nor function (F=0.856; P=0.368; ηp2 =0.048) scales of the BCTQ. Both groups experienced similar improvements in both severity (one month: Δ0.1, 95%CI -0.4 to 0.6; three months: Δ0.4, 95%CI -0.25 to 1.05) and function (one month: Δ0.25, 95%CI -0.3 to 0.8; three months: Δ0.5, 95%CI -0.2 to 1.2) outcomes. Conclusions: This clinical trial showed that ultrasound-guided methylprednisolone hydrodissection and open surgery were similarly effective in moderate-to-severe CTS patients in the short term. https://www.caspjs.com/article_735334.html Background: Colorectal cancer surgery improves outcomes but often leads to long-term physical and psychosocial challenges for patients and families. Limited evidence exists on the relationship between postoperative quality of life (QoL) and spousal caregiver burden, especially in non-Western settings. This study aimed to assess the QoL of colorectal cancer patients post-surgery and examine its association with the psychological burden experienced by their spouses. Methods: This descriptive cross-sectional study recruited 99 colorectal cancer patients and their spouses from two hospitals in northern Iran in 2023. Patients’ QoL was measured using the WHO Disability Assessment Schedule II (WHODAS II), and caregiver burden was assessed using the Zarit Burden Interview (ZBI). Adults with confirmed colorectal cancer living with a caregiving spouse were included; those with severe cognitive impairment or incomplete data were excluded. Associations were analyzed using Pearson correlation and Chi-square tests. Results: The patients’ mean age was 61.84 ± 12.10 years, while spouses averaged 51.14 ± 13.12 years. The majority underwent anterior resection (55.6%) or low anterior resection (30.3%). Patients reported moderate disability (mean WHODAS II score 22.20), particularly in social participation. The average caregiver burden was 6.98. Significant correlations existed between social participation difficulties and caregiver burden (r=0.308, p=0.002) and communication difficulties (r=0.202, p=0.045). Conclusion: Postoperative QoL among colorectal cancer patients was suboptimal, with lower QoL associated with higher caregiver burden. These findings underscore the need for family-centered care and support strategies for caregivers. https://www.caspjs.com/article_735571.html Abstract Background: Surgical site infections (SSIs) are common healthcare-associated infections that increase mortality, prolong hospital stays, and impose substantial economic costs. Aim: This review aims to clearly summarize the current evidence on the definition, classification, risk factors, common pathogens (including multidrug resistant organisms), and principles of management and prevention of SSIs, with emphasis on global guidelines to reduce infection related morbidity. Key findings: SSIs occur within 30 days post surgery and are classified as superficial incisional, deep incisional, or organ/space. Risk factors include patient related (smoking, obesity, age) and procedure related (prolonged surgery, implants, contamination) variables. Staphylococcus aureus and methicillin resistant S. aureus (MRSA) are predominant pathogens. Management involves surgical exploration, microbiological sampling, and appropriate antibiotic therapy. Prevention strategies are outlined in WHO based recommendations. Conclusion: Improving post discharge surveillance, validating risk tools, and conducting high quality trials on dressings and negative pressure therapy are future priorities. A multidisciplinary approach is essential for better outcomes. https://www.caspjs.com/article_735572.html Background: Paraneoplastic neurological syndromes (PNS) are rare immune-mediated disorders associated with malignancies, often preceding or complicating cancer diagnosis and treatment. Among them, paraneoplastic cerebellar degeneration (PCD) is a severe subtype. Case Presentation: A 41-year-old woman with high-grade serous ovarian carcinoma developed progressive cerebellar symptoms including dizziness, diplopia, gait instability, and dysarthria approximately two months after initiation of neoadjuvant carboplatin/paclitaxel chemotherapy. Neurological examination revealed nystagmus, positive Romberg test, and ataxic gait. Brain and spinal MRI were unremarkable. Differential diagnoses including cerebellar stroke, multiple sclerosis relapse, chemotherapy-induced neurotoxicity, and metabolic encephalopathy were excluded. Although onconeural antibody testing (Anti-Hu, Anti-Yo, Anti-Ri, and Anti-Ma2) was not available, the clinical presentation supported a probable diagnosis of PNS. The patient received high-dose intravenous immunoglobulin (0.4 g/kg/day for 5 days), corticosteroids (methylprednisolone 1 g/day for 5 days), and plasmapheresis, resulting in partial neurological improvement. Outcome: Following cytoreductive surgery and continuation of oncologic management, gradual improvement in neurological symptoms was observed over four months, although residual gait impairment persisted. Conclusion: PNS should be considered in patients with ovarian cancer presenting with unexplained neurological symptoms despite normal imaging. Early recognition and immunotherapy may improve outcomes. https://www.caspjs.com/article_735735.html Background: Depression is highly prevalent in patients following coronary artery bypass graft (CABG) surgery and negatively affects recovery and prognosis. Selecting an appropriate antidepressant in this cardiac population remains a clinical challenge. Objective: This study aimed to compare the efficacy and safety of bupropion versus escitalopram in the treatment of major depressive disorder (MDD) in post-CABG patients. Both medication have limited cardiac side effects and drug intraction. Methods: In a double-blind, randomized controlled trial, 100 patients diagnosed with post-CABG depression based on DSM-5 criteria were assigned to receive either bupropion (150–300 mg/day) or escitalopram (10–20 mg/day) for 8 weeks. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-II (BDI-II) at baseline, and after 2, 4, and 8 weeks of treatment. Primary outcome was change in HAM-D score; secondary outcome was change in BDI-II. Results: Both groups demonstrated significant improvements in depression scores over time. At week 8, mean HAM-D scores decreased from 15.8 to 8.1 in the bupropion group and from 16.3 to 7.8 in the escitalopram group (p > 0.05). Similar patterns were observed in BDI-II scores. No serious adverse events were reported. Conclusion: Following cardiac surgery, the risk of developing symptoms of depression and anxiety is high. Identifying and determining of suitable medication with low cardiac vascular side effects and interaction is helpful in clinical decision making for physician. Both tracs were equally effective and well-tolerated in treating post-CABG depression. The findings support flexible antidepressant selection based on individual patient profiles.