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Introduction/background: This study was designed to investigate the amount of time saved and the degree of contour difficulty between the two methods of contouring, mouse/keyboard, versus touch screen/stylus in radiotherapy., Methods: Each of 94 patients consisting of 26 breast cancer cases, 24 lymph nodes cases, 25 rectal cancer cases, and 19 heart cases has been contoured twice. One with a mouse/keyboard, and the next one with the touch screen/stylus. Three radiation oncologists participated in this study. Contouring information including measured time, estimated time spent, volume of contour performed and organ contoured are recorded. To evaluate the differences between the contouring methods, the results regarding target volume and time to completion were analyzed using two-way robust ANOVA. Ease of use and contouring difficulty were compared for differences in distribution of the response choices between the groups using Pearson chi-square test., Results: In this study, 94 clinical cases were studied. The average time required for contouring with the touch screen/stylus method was half the time needed for contouring patients with the mouse/keyboard method. The reduction in the time in breast cancer cases was the highest (48.2%) and the lowest in head and neck cancer cases (32.4%). In comparing the contoured volumes, no significant difference was observed between the two methods. the mean estimated time reported by the radiation oncologist in the mouse/keyboard method was 5.6 minutes longer and, in the touch screen/stylus method, was 3.9 minutes less than the actual measured time., Conclusions: All the measured and analyzed variables show the superiority of contouring with the touch screen/stylus method and reduced the time required for patient contouring by an average of 50%., (Copyright © 2024. Published by Elsevier Inc.)

Introduction  Due to the worldwide growing number of transgender individuals openly identifying themselves, including in Iran, these individuals need more attention and support. This study compares patient satisfaction and quality of life after female-to-male gender confirmation surgery using an anterolateral thigh (ALT) flap and radial forearm free flap (RFFF). Materials and Methods  This study included 49 patients who underwent phalloplasty from 2014 to 2019 using two different methods. The two groups' outcomes and quality of life were investigated and compared 1 year after the operation. Results  The mean age of the patients in this study was 32.7 years. Among patients, 44.9% underwent revision operations, and 38.8% had residual protective sensations after 1 year. In terms of quality of life after surgery, the general shape of the phallus, cold and heat sensation, sense of touch, the body of glans and shaft, color and size of the phallus, sexual pleasure in patients and their partners, and the relationship between the number of anastomosed nerves and sexual satisfaction, there was no statistically significant difference between the two groups. The ALT group had statistically significantly higher rates of orgasms compared to the RFFF group. Conclusion  The outcomes of the two phalloplasty surgery methods (ALT and RFFF) are similar in different aspects, such as the quality of life., Competing Interests: Conflict of Interest None declared., (Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background and Objectives  Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods  This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results  Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain ( p  < 0.001) and lower scar length ( p  < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion  The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome., Competing Interests: Conflict of Interest None declared., (Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Peripheral nerve damage is a very important factor in patients' quality of life and functionality for various reasons. We aimed to compare the functionality level, disability and quality of life in subjects with peripheral nerve repair in the upper extremity., Methods: This cross-sectional study was conducted on patients with nerve injuries in 2019. Among those patients, Eighty-five were selected as the sample. The instruments used in this study included the health-related quality of life standard questionnaire (SF-36), and the disability of the arm, shoulder and hand questionnaire (DASH-38). Data were analyzed by SPSS software version 22 and one-way ANOVA and Kruskal-Wallis statistical tests., Results: Results of the Kruskal-Wallis test showed that the disability score in the groups of patients was not significant. In addition, according to the results of the one-way ANOVA test, the quality of life score was not significant among the patient groups., Conclusion: Considering that peripheral nerve damage has a significant impact on patients' quality of life and functionality, apart from more research on the subject, it is necessary to provide support for patients to improve their quality of life., Competing Interests: The authors declare that there is no conflict of interests.

This study aims to explain microscopic replantation in a rare case of a wholly amputated penis after prolonged ischemia. A 36-year-old patient underwent microscopic replantation of the penis after 9 hours. The penis was completely amputated due to self-mutilation. Microvascular replantation was performed after pre-operative preparation. On the second day after surgery, congestion was observed in the penis, and three sessions of leech therapy were conducted each time the leeches were placed for 30 minutes and then detached by themselves. The patient was referred to a psychiatrist to continue treatment after discharge from the hospital. Penile amputation is a rare situation and has different causes. There are various treatments to repair the amputated penis, which are both microvascular and microvascular. The microsurgery methods have shown the best results. In the present case, due to microsurgical artery repair and the early start of leech therapy, there was limited and predictable necrosis in the area of the penoscrotal junction flap, which underwent debridement and skin graft. Complete amputation of the penis is a rare phenomenon. Efforts should be made to perform the replantation surgery as soon as possible. The venous outflow is an essential factor in the success of penile re-implantation, and completely restored vascular and sensory function in this case. Early initiation of psychological care to control underlying disease leads to further cooperation of the patient to handle complications and avoid the recurrence of self-injury., Competing Interests: The authors declare that there is no conflict of interests.

Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries' epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%) and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low-voltage injuries were more common (n = 649, 89%). Most incidents happened at the workplace (n = 459, 63%). Comparison of patients with high-voltage and low-voltage injuries showed significant correlations and statistical difference between these two groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture, and mortality rate (P = .001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low-voltage injuries were more common than high-voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce the number of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Trials of intraoperative chemical splanchnicectomy during resection of pancreatic and gastric masses resulted in significant difference in a patient's postoperative pain. This study aims to determine if splanchnicectomy by alcohol neurolysis can relieve postoperative pain after gastrectomy and Whipple surgery. The study explores differences in outcomes at first four months after surgery., Methods: Fifty-eight patients with gastric and 60 patients with pancreatic resectable masses were included (28 were lost to follow-up). Each randomized in control and intervention subgroups. Intervention subgroups underwent chemical blockage of celiac ganglions by ethanol injection at both sides of suprapancreatic aorta. Participants were asked to report their pain intensity according to the Visual Analogue Scale (VAS) at specific times., Result: The overall postoperative pain of injected Whipple and gastrectomy subgroups was lower than the noninjected Whipple and gastrectomy subgroups ( p < 0.001). The pain-modifying effect of the injection was not different between Whipple and gastrectomy groups ( p =0.125)., Conclusion: Splanchnicectomy is recommended for pain reduction after abdominal operations. Perspective . This article presents positive effect of intraoperative chemical splanchnicectomy during resection of pancreatic and gastric masses on postoperative pain. This is an easy, effective, safe, and inexpensive procedure recommended for all operable gastric or pancreatic masses to palliate the pain degree., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Jalal Vahedian et al.)

Desmoid tumors are locally aggressive and non-metastatic neoplasms with a high rate of recurrence. Desmoid tumors of the pancreas are, however, very rare, and only a few cases have been reported in the literature. This paper reports an anecdotal case of a diffuse pancreatic desmoid tumor with the involvement of the pancreatic head, body, and-partially-tail. The patient underwent the Whipple procedure and subtotal pancreatectomy. Histopathological assessment showed that the tissues were partly positive for smooth muscle actin, but not for S100 or PanCK. The Ki67 index of the cells was only 1 %. Unfortunately, the patient died on the 10th postoperative day due to massive upper gastrointestinal bleeding.

Background: Pancreatic cancer is generally found in the older population Pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. Allen. O Whipple was the first to describe pancreaticoduodenectomy in 1935 as a modified procedure. This article is a case series with respect to the 7-year experience of the Whipple procedure in Firoozgar Teaching Hospital., Methods: Patient surgery details were gathered from the surgical records of the operating room and their clinical records from the hospital archives. Data was analyzed with SPSS software (version 16.0.1). Those patients, whose tumor had invaded the superior mesenteric artery, had extensive portal vein involvement or distant metastasis was considered as unresectable., Results: The first Whipple procedure was recorded in our hospital in 2008. From 2008 till 20 March 2014, 70 cases were collected and analyzed. The mean age of cases was 58.4 years, the mean hospital stay length was 12.9 days (±6.23 days), mean operation time was 376 min (±37.3 min),. The most common presenting symptom was jaundice (78.6 %). Delayed gastric emptying was the most common post-operative complication. The most prevalent cause of reoperation was intra-abdominal abscess. Major morbidities of these patients consisted of cardiac arrhythmias (21.4%) and pneumonia (10%). Minor complications were wound infection (17.1%) and delayed gastric emptying (32.9%). The statistics revealed pancreatic anastomosis failure as 2.9% and a decrease in mortality rate from 50% during the first years of this study to 16% to 20% during the last years., Conclusions: In this case series, the time of operation decreased during the recent years .Analysis shows a correlation between operation time and pack cell transfused during the operation, but no correlation was found between operation time and post-operation hospitalization course. It is true that hospital setting, socioeconomic level of the patients including their compliance, and the expertise of the surgeons and surgical staff can have an influence on the result of this operation, but it seems that the magnitude of the surgical stress of this procedure and the (compromised) functional reserve of this patient population can be a notable factor influencing the outcome.

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.