Rejected

To review a series of patients with brain metastases from ovarian cancer at a single institution. To describe treatment modalities, their outcomes and to determine prognostic factors.

Double pylorus is one of the rare endoscopic findings consisting of two communication channels between the gastric antrum and the first part of the duodenum. It has no specific signs and symptoms. It is usually detected incidentally during endoscopic examination performed with nonspecific dyspeptic complaints such as epigastric pain, nausea, vomiting, and bloating. But contrary to expectations our patient applied to the emergency department with the complaint of melena that had been going on for 3 days. Her hemoglobin value was 9.7 mg/dL, blood ure nitrogen value was 65 mg/dL. Rectal touch examination was compatible with melena. In the emergency endoscopy of the patient, two channels were seen in the pylorus region. In the accessory canal, there was an ulcer of 10 mm in size with adherent dots and white exudate. The biopsy was reported as chronic gastritis due to H.pylori infection. Ibuprofen treatment used by the patient was discontinued and the patient was given high double dose PPI and H.pylori eradication therapy. Double pylorus, which is usually found incidentally in endoscopy with nonspecific findings, may very rarely present with GI bleeding findings, as in our patient. It is necessary to avoid risk factors in double pylorus, to give antiulcer and H.pylori treatment in its presence for an optimal time regardless of whether the double pylorus continues or not.

One of the most feared symptoms of any disease is PAIN. It is a complex phenomenal experience, especially in children. Various methods and medications have been administered through different routes. Regional anesthesia produces marvelous postoperative analgesia and cessation of stress response in infants and children. Caudal epidural analgesia is the most acceptable and popular method of providing intra- and postoperative analgesia for abdominal, perineal, and lower limb surgeries in children. The use of preservative-free morphine as an adjunct to ropivacaine increases the quality and duration of analgesia despite the various side effects. Various articles use various doses of morphine as an adjuvant in caudal epidural analgesia. Hence, we conducted the study to compare the two dosages of morphine that is 20 μg.kg and 30 μg.kg of caudal epidural morphine for infraumblical surgeries with regard to its efficacy and safety and side effect profiles.

Posterior fossa lesions can occur in patients of all ages. Patients present with subtle findings of hearing loss, tinnitus, headache, cranial neuropathies, imbalance, vertigo, nausea, and vomiting depending on the location and type of lesion. The presentation can be particularly insidious as the most common symptom is slowly progressive hearing loss. Posterior fossa lesions should be included in the differential diagnosis for patients with this presentation and appropriate audiologic testing and imaging should be performed. Management involves collaboration between multiple subspecialties and has evolved significantly over the years leading to increased patient involvement and improved outcomes.

This study aims to compare levobupivacaine 0.125% and ropivacaine 0.2% with fentanyl as epidural drugs for labor analgesia using combined spinal epidural (CSE) technique regarding time for onset, duration of analgesia achieved by first epidural bolus dose and to compare the quality of labor analgesia. In addition, the study is also designed to assess the maternal and fetal outcome, incidence of instrumental delivery, degree of motor blockade, and maternal satisfaction.

Celiacomesenteric trunk (CMT) refers to the common origin of celiac trunk and superior mesenteric artery which is a very rare anatomical variation. CMT is incidentally diagnosed during angiography or abdominal computed tomography scanning. The diagnosis of CMT may inform surgical practice and prevent damage during invasive radiologic procedures, lowering thus the rate of iatrogenic errors. Complete common mesentery is in its turn a rarer congenital anomaly that arises from an abnormal rotation of primitive small intestine during embryonic development. We report a case of a 48-year-old man, suffering from chronic abdominal pain, and postprandial discomfort. The patient underwent an abdominal contrast-enhanced computed tomography that detected a CMT associated with common complete mesentery. According to our review of bibliography, this is the first case report to simultaneously report both congenital anomalies (CMT and common complete mesentery). Furthermore, the CMT described here has not been described in previous classifications and represent a novel anatomical variation of CMT.

Fixed bearing (FB) UKA constituted 63.7% of unicondylar knee arthroplasties in 2020 Australian Registry with the longest UKA survivorship. The significance of patellofemoral joint (PFJ) arthritis, ACL deficiency, post-operative anteromedial pain, radiosclerosis or radiolucency on survivorship of FB UKA is not established. The aim of this study was to analyze the medium-term survivorship of fixed-bearing UKA with no exclusion of PFJ OA and ACL deficiency. Predictors for failure were analyzed.

Simultaneous occurrence of immune-based gastrointestinal diseases and autoimmune hepatitis, although not common, is of clinical importance. Some clinical and laboratory findings such as severe pruritus and elevated alkaline phosphatase raise suspicion of a biliary disease which overlaps autoimmune hepatitis. A strong clinical suspicion of overlap syndrome in a patient with autoimmune hepatitis prompts more diagnostic evaluations like MRCP, liver biopsy, and secondary laboratory tests. Patients who fall into the category of overlap syndrome proceed with timely monitoring of known complications including colorectal carcinomas, cholangiocarcinomas, and gallbladder cancers. It is strongly recommended that all simultaneous immune-based involvements be searched prior to labeling a patient as having pure autoimmune hepatitis. The current study attempted to express all challenges about a case with overlap syndrome referred to the gastroenterology ward of Taleghani Hospital and to review the latest articles and related guidelines about the diagnosis, treatment, complications, and surveillance of the mentioned patient with autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and inflammatory bowel disease (IBD).

This observation aimed to investigate the effect of colorectal neoplasia differentially expressed (CRNDE) targeted miR-212-5p on cognitive impairment induced by isoflurane (ISO) anesthesia in rats.

Dexmedetomidine is used as an adjuvant to local anesthetic agents to provide prolonged analgesia in peripheral nerve blocks. This study aimed at determining the optimal dose of dexmedetomidine, which when combined with ropivacaine will produce a superior quality block in terms of extended pain-free period and reduced perioperative analgesic/opioid use, which in turn improves patient satisfaction.