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Abstract Background Surgical resection of colorectal cancer liver metastasis (CRLM) has been associated with improved survival in these patients. The purpose of this study was to investigate the usefulness of liver metastasectomy, also finding independent factors related to survival after liver metastasectomy. Methods In a retrospective study, all patients with CRLM who underwent resection of liver metastases between 2012 and 2022 at Imam Khomeini Hospital Complex in Tehran, Iran, were enrolled. All patients were actively followed based on clinicopathologic and operative data. Results A total of 248 patients with a median follow-up time of 46 months (Range, 12 to 122) were studied. Eighty-six patients (35.0%) underwent major hepatectomy, whereas 160 (65.0%) underwent minor hepatectomy. The median overall survival was 43 months (Range, 0 to 122 months), with estimated 1-, 3- and 5-year overall survival rates of 91%, 56%, and 42%, respectively. Multivariate analysis demonstrated that a metastasis size > 6 cm, major hepatectomy, rectum as the primary tumor site, and involved margin (

Abstract Background and Recent findings Gastric cancer (GC) has been known as one of the most common causes of cancer mortality both in Western and Eastern countries. However, there might be differences between how it is managed in different countries. Thus, we aimed to investigate these differences. Materials and Methods The most well‐known clinical guidelines in field of GC management including Korean GC Association (KGCA), Japanese GC Association (JGCA), National Comprehensive Cancer Network (NCCN), European Society for Medical Oncology (ESMO), British Society of Gastroenterology (BSG), and National Institute for health and Care Excellence (NICE) have been reviewed. Results The contents of these guidelines were categorized under eight headings including (1) genetic predisposition, (2) prevention, (3) management of gastric polyp, atrophy, dysplasia and metaplasia, (4) diagnosis, (5) pathology and molecular biology, (6) treatment, (7) supportive and palliative care, and (8) follow up. Difference in each section was discussed. Conclusion Considering KGCA and JGCA as Eastern and NCCN, ESMO, BSG, and NICE as Western guidelines, it is revealed that both sets of guidelines share common practices such as prioritizing comprehensive diagnostic evaluations, personalizing treatment plans, and palliative care. However, main differences can be seen in treatment regimens, the adoption of newer therapies like immunotherapy, and the utilization of emerging techniques such as HIPEC. These differences reflect the diverse clinical landscapes, research focuses, and healthcare systems within these regions.

Background: Lower gastrointestinal bleeding, a symptom that can become the cause of a life-threatening condition, has a 33 per 100,000 prevalence. The origin of lower gastrointestinal bleeding in most cases is the small intestine, colon, or anorectal parts. Surgical consultation in patients with gastrointestinal bleeding is one of the most necessary measures so that the patient can be treated at the appropriate stage with a greater chance of success before reaching shock. In the case of uncontrolled gastrointestinal bleeding, surgery is recommended as soon as possible when endoscopic and radiological treatments are not possible or effective. Case Presentation: In this article, we present a case of uncontrolled lower gastrointestinal bleeding in a 50-year-old patient who was admitted to Imam Khomeini Hospital in Tehran on December 15, 2021. Despite performing appropriate paraclinic measures such as sonography, endoscopy, and colonoscopy the gastrointestinal bleeding origin was not determined. On the other hand, our investigations showed that she had liver cirrhosis. Due to the instability of the patient's condition due to continued lower gastrointestinal bleeding, the medical team decided to perform surgery. The surgeon noticed that the origin of the bleeding was a vascular entanglement at the small intestine-navel junction, and the procedure involved segmental excision of the small intestine. Conclusion: In cirrhotic patients, lower gastrointestinal bleeding is an emergency condition, and if the source of the bleeding is not accessible via endoscopy or colonoscopy, diagnosing and treatment become extremely difficult. Computed tomography angiography and subsequent surgery are effective approaches for diagnosing and treating these conditions. When lower gastrointestinal bleeding is uncontrolled, exploratory laparotomy should be considered. Due to the unknown origin of bleeding, exploratory laparotomy may not be successful, so using endoscopy during surgery can help to diagnose the location of the lesion in these cases; However, in some cases despite all measures, the source of bleeding may not be determined, in these case the rate of rebleeding after surgery will be high.

Abstract Background Although the gastrointestinal tract is one of the most common sites for extranodal lymphoma, gastrointestinal lymphoma is a rare disease that is almost exclusively non-Hodgkin lymphoma. Case presentation We present a rare condition of Hodgkin lymphoma relapse after 12 years as isolated gastric involvement caused massive gastrointestinal bleeding in a 34-year-old Iranian woman. According to the result of the upper endoscopy, laparotomy was performed, and a large mass in the upper part of the fundus, alongside the esophagogastric junction, was seen, so gastrectomy was performed. Conclusion All symptoms and paraclinical findings for gastrointestinal Hodgkin lymphoma are nonspecific. Therefore, the preoperative diagnosis is challenging. It seems that surgery is a suitable diagnostic and therapeutic method in this field.

Introduction: Interfractional set-up variations may cause deviation of the delivered dose from the planned dose distribution. This study aimed at calculating random and systematic set-up errors using an electronic portal imaging device (EPID) to set the optimum planning target volume (PTV) margins in patients with head and neck cancer who were under treatment with three-dimensional conformal (3DCRT) and intensity-modulated radiotherapy (IMRT). Material and Methods: In this study, 50 patients underwent 3DCRT along with weekly electronic portal image (EPI), and daily IMRT imaging was performed on 50 others. The EPIs were compared with Digitally Reconstructed Radiographs (DRRs) to quantify the systematic, random, and 3D vector length of set-up errors in three translational directions (X, Y, Z). The PTV margins were measured utilizing International Commission on Radiation Units and Measurements report 62, Stroom’s and van Herk’s models. Results: For 3DCRT and IMRT techniques, the overall mean 3D vector length of displacement was obtained at 3.9 and 2.7 mm, respectively. The maximum systematic and random errors were 1.3 and 1.9 mm for the IMRT technique and 2 and 2.9 mm for 3DCRT, respectively. PTV margins in the three acquisition directions were 2-7.2 mm. Conclusion: It was found that a 7 mm extension of the clinical target volume (CTV) to PTV margin ensures that 90% of head and neck cancer patients have received 95% of the planned dose.

Since the first wave of COVID-19, different methods for management of COVID-19 ARDS were proposed. Early intubation and mechanical ventilation was performing more than other methods. after several mounths, limitation of equipment in hospitals, made the specialists think of less aggresive methods. NIV was one of suggestion performed before intubation which improve oxygenation of patients. They don't get any sedation and have regular diet. As a result, the need for ICU and ventilator for respiratory support decreases. In this case study, we report a patient that had permanent tracheostomy and hospitalised for COVID-19 ARDS. At first we connected the tracheostomy to a CPAP devise.

Abstract Background Acute abdomen is among the most common presentations observed in clinical practice. The present study describes a patient with isolated duodenal ischemia as an extremely rare etiology of acute abdomen. Case presentation A 79-year-old male with acute abdominal pain, nausea, and vomiting presented to the emergency department of our hospital. He was diagnosed with myelodysplastic syndrome 7 years ago, for which he took thalidomide and erythropoietin as the main medications. The prominent findings of the physical examination were hypotension, tachycardia, fever, mild hypoxemia, and epigastric and right upper quadrant tenderness of the abdomen. Except for mildly increased creatinine and lipase, other laboratory findings were in concordance with myelodysplastic syndrome. Due to the patient’s oliguria, the computed tomography (CT) scan was performed without contrast, which, together with the ultrasonography, raised the clinical impression of acute pancreatitis. The patient’s hypotension was refractive to supportive treatment, resulting in progressive deterioration of the clinical condition. A later contrast-enhanced CT scan suggested microvascular ischemia of the duodenum. An emergent Whipple’s procedure was planned initially, which was later switched to a damage control surgery due to the patient’s cardiac arrest during the surgery. Despite all the supportive therapy provided at the intensive care unit, the patient expired of a cardiac arrest which occurred two hours after the termination of the surgery. Conclusions The high rate of mortality in duodenal necrosis necessitates emergent diagnosis and proper management. When other common etiologies are ruled out, clinicians should consider duodenal pathology as a potential cause of acute abdomen.

In this case report, a man presenting with a rare symptom of appendix cancer is dis- cussed. Hematuria, which was the key diagnostic feature in this patient, has never been re- ported as a presenting feature of appendix cancer which may explain why this patient has been experiencing this symptom for months and yet have not get the proper di- agnosis. As we discussed in the case report, although appendiceal cancer is a potentially life-threatening issue, it is frequently missed in patients. Therefore, we believe report- ing this key symptom in this journal would help physicians to make a more accurate diagnosis in this matter.

IntroductionGastrointestinal symptoms are common among COVID-19 patients. Although gastrointestinal involvements are mostly benign, they rarely indicate a severe pathology like intestinal ischemia. The present case series describes 21 patients with bowel ischemia, necrosis, or perforation.MethodsThe present case series was conducted from April 2020 to February 2022 in the surgical wards of two Iranian hospitals. We retrospectively included adult patients with concomitant COVID-19 and intestinal ischemia. Primary outcomes were defined as the length of stay and survival.ResultsTwenty-four patients with a median age of 61.5 years were included in the study. Sixteen (67%) patients were male, and 13 (54%) were without any comorbidities. Macrovascular mesenteric ischemia was not identified in 21 patients (87.5%). Gastrointestinal manifestations appeared on the median of seven days (range 2–21) after the diagnosis of COVID-19, with the most common symptom being abdominal pain. All the patients had a significantly elevated C-Reactive Protein prior to surgery, ranging from 68 to 362. D-dimer was measured in eight patients and was significantly elevated, ranging from 1,878 to over 5,000 ng/mL. One patient was managed conservatively due to a good clinical condition. Except for one patient with angioinvasive mucormycosis and one other with leukocytoclastic vasculitis, pathologic evaluation revealed general features of intestinal necrosis, including ulcer, hemorrhage, necrosis, neutrophilic infiltration (in seven patients), neutrophilic abscess (in four patients), and edema. Bowel necrosis accompanied mortality of 15 (62.5%) patients and a median of 6.5 days of hospital stay.ConclusionIntestinal ischemia in COVID-19 patients is associated with a high mortality rate. Further research is needed to elucidate the dynamics of intestinal ischemia in the setting of COVID-19.

Purpose. The COVID-19 pandemic has overwhelmed many healthcare systems. Seasonality is a feature of several infectious diseases. Studies regarding the association of seasonal variations and COVID-19 have shown controversial results. Therefore, we aimed to compare COVID-19 characteristics and survival outcomes between the fourth and fifth waves in Iran, which corresponded to spring and summer, respectively. Methods. This is a retrospective study on the fourth and fifth COVID-19 waves in Iran. One hundred patients from the fourth and 90 patients from the fifth wave were included. Data from the baseline and demographic characteristics, clinical, radiological, and laboratory findings, and hospital outcomes were compared between the fourth and fifth COVID-19 waves in hospitalized patients in Imam Khomeini Hospital Complex, Tehran, Iran. Results. The fifth wave patients were more likely to present with gastrointestinal symptoms than the patients from the fourth wave. Moreover, patients in the fifth wave had lower arterial oxygen saturation on admission (88% vs. 90%; P=0.026), lower levels of WBCs (neutrophils and lymphocytes) (6300.00 vs. 8000.00; P=0.004), and higher percentages of pulmonary involvement in the chest CT scans (50% vs. 40%; P

Background: The surgery for a breast imaging-reporting and data system (BIRADS) IV lesions needs imaging or pathology supporting data. The roll of breast scintigraphy for this purpose is unclear. Materials and Methods: In a prospective design, 16 patients with 25 BIRADS IV lesions who were scheduled for surgery were included. Before the surgery, breast scintigraphy was done using a nondedicated dual head gamma camera in the prone position employing a shaped foam pad providing imaging at breast pendulous position. Twenty mCi 99 mTc methoxy-isobutyl-isonitrile was injected and two 15 and 60-min delayed imaging were done (anterior, bilateral, and single photon emission computed tomography [SPECT] projections). Pathology reports were collected and tumor to nontumor uptake ratio (T/NT) was analyzed, accordingly. Results: Out of all lesions, 12 were malignant (invasive ductal and lobular carcinoma ductal carcinoma in situ). At 15 min, T/NT was insignificantly higher in the malignant compared to benign lesions (22.8 ± 23.9 vs. 10.1 ± 10.1; P = 0.109). The optimal T/NT cutoff for discrimination of malignant and benign lesions was 20. Only 1 out of 13 benign lesions presented uptake >20 (7.7%; false-positive rate; P = 0.047). The diagnostic accuracy, sensitivity, and specificity for T/NT calculated at 0.68, 0.42, and 0.92, respectively. The T/NT at 60 min remained unchanged for either benign or malignant lesions (22.3 ± 30.2 vs. 11.7 ± 17.1; P = 0.296). Conclusions: Breast scintigraphy with general purpose gamma camera employing SPECT imaging may assist the selection of BIRADS IV lesions in need for surgery. All uptake positive cases should undergo surgery and decision for uptake negative cases should be made based on other data.

Background: The AJCC pN-staging system is the current risk stratification strategy for axillary nodal staging in most cancer centers. Recently, another staging system named "Lymph Node Ratio" or LNR has been developed and also postulated to have prognostic value. Precise prognostication of breast cancer by these two systems has multiple methodological dilemmas which are overlooked in the literature and still remain matters of debate. Methods: These two issues are categorized into seven queries, including: the number of nodes considered adequate for proper axillary staging; attitude toward Z-0011 trial; impacts of neo-adjuvant therapies; the origin and evolution of stratification cutoffs; the position where patients without axillary involvement should be placed; role of diverse endpoints in survival definition, outcome analyses and prognosis prediction; and ultimately the current opinion regarding the superiority between the two systems. This review sought to explore these topics through analysis of 58 recently published articles found by MEDLINE search. Results: The analysis revealed that precise prognostication by pN-staging system requires at least 10 excised-nodes, but LNR system minimally depends on the quantity of excised-nodes. Adhering to Z-0011 trial findings obstructs the provision of sufficient nodes for pN-staging. Neo-adjuvant chemotherapy alters the axillary nodal climate and therefore disrupts proper axillary staging. Cutoffs of LNR system have a more clear history of formation than the pN-staging's. Breast cancer-specific survival is the type of survival better portraying cancer-related events. Conclusions: LNR system seems at least as accurate as pN-staging in prognostication of breast cancer patients.