Publications by authors named "Alimohammad Bananzadeh"

17 Publications

  • Page 1 of 1

Two cases of primary leiomyosarcoma of sigmoid colon treated with laparoscopic surgery: A case report and a review of literature.

Int J Surg Case Rep 2021 Sep 16;87:106420. Epub 2021 Sep 16.

Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Introduction And Importance: Leiomyosarcoma (LMS) of the colon is an extremely rare and highly invasive tumor arising from the muscularis propria of the gastrointestinal tract. After the introduction of oncogenic role of KIT by immunohistochemistry (IHC), the reported cases of gastrointestinal leiomyosarcoma were highly limited. True LMS of the colon is such a rare disorder that there isn't much description of its nature.

Case Presentation: We reported two very rare cases of primary leiomyosarcoma of sigmoid colon, which referred to our institution with symptoms of abdominal pain, lower GI bleeding and fatigue. After the initial investigations, both patients were diagnosed with primary LMS of sigmoid colon that underwent laparoscopic tumor resection.

Clinical Discussion: The classical colonic LMS presents with a vast majority of non-specific symptoms including mild abdominal pain, fresh/obscure rectal bleeding, and weight loss. The most common location for colonic LMS is the sigmoid colon, and ascending colon. The prognostic factors for the disease outcome have not been established properly; however, patient age, tumor size/grade, and local/distant dissemination are of great importance.

Conclusion: Herein, we reported two rare cases of primary leiomyosarcoma of sigmoid colon that was treated with laparoscopic surgery.
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http://dx.doi.org/10.1016/j.ijscr.2021.106420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455635PMC
September 2021

How Does Fat Mass Change in the First Year After Bariatric Surgery? A Systemic Review and Meta-Analysis.

Obes Surg 2021 08 5;31(8):3799-3821. Epub 2021 Jun 5.

Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

This systematic review and meta-analysis investigated the time-course effect of different type of bariatric surgeries (BS) up to 1 year post-surgery on fat mass (FM) and body fat percentage (BFP) in patients with morbid obesity. We searched PubMed, Scopus, EMBASE, ISI web of science, and Cochrane databases from October 2002 until May 2020 with no restriction in the English language, to find studies examining the effect of BS on FM (kg) and BFP (%) in morbid obese patients. Meta-analysis of 103 studies carried out on data of 18,166 and 14,575 morbid obese patients following BS, showed that BS was associated with a substantial decrease in FM and BFP, respectively, in 1 month (- 8.17 kg [95% CI - 9.07, - 7.27] and - 1.51% [95% CI - 2.56, - 0.46]), 3 months (- 15.75 [95% CI - 17.49, - 14.0] and - 4.90 [95% CI - 5.97, - 3.83]), 6 months (- 22.51 [95% CI - 23.93, - 21.09] and - 8.56% [95% CI - 9.63, - 7.49]), and 12 months (- 29.69 [95% CI - 31.3, - 28.09] and - 13.49% [95% CI - 14.52, - 12.40]) after the surgery. In conclusion, BS was associated with sustained declines in FM and BFP, from 1 to 12 months, with no indication of plateau phase post-surgery post-operatively. The present study emphasizes that post-bariatric care should have more focus on FM loss during 1-year post-surgery to identify the patients at risk for fat loss plateau.
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http://dx.doi.org/10.1007/s11695-021-05512-9DOI Listing
August 2021

Prognostic Factors of Rectal Cancer in Southern Iran.

J Gastrointest Cancer 2020 Nov 19. Epub 2020 Nov 19.

Department of Epidemiology, School of public health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Rectal cancer accounts for one-third of all colorectal cancer (CRC) cases. Due to physiological and anatomical differences, some researchers consider rectal cancer as a separate organ malignancy during the recent decades. However, limited studies have been conducted in this regard in Iran. Therefore, the aim of this study is to determine survival of rectal cancer and its affecting factors in Fars province, southern Iran.

Methods: In this cohort study, we used the data of 387 patients with rectal cancer gathered by the Colorectal Research Center of Shiraz University of Medical Sciences between 2007 and 2015. The impact of 35 explanatory factors including demographic information, medical history, pathologic data, and imaging findings was evaluated using Cox regression analysis.

Results: Out of all patients, 111 ones (29%) died. The median follow-up period was 36 months. The patients' mean age at diagnosis was 56.72 ± 13.89 years. Their 5-year survival was 65% (95% CI: 58-69%). The results of multiple Cox regression analysis showed that sex (male/female; HR = 1.73, 95% CI: 1.15-2.67), vascular invasion (yes/no; HR = 2.40, 95% CI: 1.45-3.99), and lymph node ratio (> 0.2 vs ≤ 0.2; HR = 2.19, 95% CI: 1.41-3.40) were significantly correlated to survival.

Conclusion: Various geographical parts of Iran show different rates regarding rectal cancer survival. A better 5-year survival rate was detected by this study for the patients with rectal cancer in Fars province, southern Iran, compared to many parts of the country. Moreover, gender, vascular invasion, and nodal status played an important role in survival of rectal cancer.
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http://dx.doi.org/10.1007/s12029-020-00553-2DOI Listing
November 2020

Prognostic Factors Affecting Short- and Long-Term Recurrence-Free Survival of Patients with Rectal Cancer using Cure Models: A Cohort Study.

Iran J Med Sci 2020 Sep;45(5):333-340

Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Understanding the prognostic factors affecting the recurrence-free survival (RFS) of patients with rectal cancer (RC) is the mainstay of care. The present study aimed to identify factors affecting both short- and long-term RFS of patients with RC using semiparametric mixture cure models.

Methods: The data were obtained from the database of the Colorectal Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, which was collected during 2007-2017. To determine the factors affecting recurrence, cure models were applied to short-term and long-term RFS of patients with RC separately. The cure rate was calculated using the smcure package in R 3.5.1 (2018-07-02) software. P<0.05 was considered statistically significant.

Results: Out of the 376 eligible patients with RC, 75.8% of men and 74.5% of women were long-term survivors. The mean age of the patients was 57.0±13.8 years. Lymph node ratio (LNR)≤0.2 increased the probability of short-term RFS. The prominent factors affecting long-term RFS were body mass index (BMI)<25 kg/m (OR=1.98, P=0.047), tumor-node-metastasis (TNM) stage (OR=6.48, P<0.001), abdominal pain (OR=2.15, P=0.007), and computed tomography (CT) scan detected pelvic lymph nodes (OR=3.40, P=0.01). Over a 9-year follow-up period, the empirical and estimated values of cure rates were 75.3% and 83.9%, respectively.

Conclusion: The results showed that factors affecting short-term RFS might be different from long-term RFS. A lower BMI was related to a poorer prognosis in patients with RC. Early diagnosis leads to a lower TNM stage and could increase the probability of long-term RFS.
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http://dx.doi.org/10.30476/ijms.2020.72735.0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519398PMC
September 2020

Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact.

Infect Drug Resist 2019 6;12:2437-2444. Epub 2019 Aug 6.

Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the rational use of prophylactic antibiotics and its cost-saving effect in gastrointestinal surgery by clinical pharmacist intervention.

Methods: A pre and post intervention study was carried out between October 2017 and June 2018 on patients who underwent gastrointestinal surgery in a major referral teaching hospital in Shiraz, southern Iran. The intervention phase consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, and arranging several meetings with the surgical department regarding the appropriate utilization of antibiotics. Differences in antibiotic utilization in patients before and after the intervention phase were compared. Exposures were surgical antimicrobial prophylaxis timing and agents, and main outcomes were incidence of surgical site infection and length of hospital stay.

Results: A total of 430 patients were included in the post intervention phase, while 445 patients were included in the baseline evaluation. Promoting appropriate antibiotic use in the post intervention group had the potential to decrease medication costs by reducing unnecessary prescriptions and duration of antibiotic usage (<0.001). In the pre intervention group, the mean cost of antibiotic prescriptions was 11.5 times that of the post intervention group. Mean hospitalization in the pre intervention group was greater than the post intervention group (<0.001). Furthermore, our data revealed that the rate of postsurgery infection in the post intervention group was 3.03%, while this rate was 6.76% in the preintervention group (=0.01).

Conclusion: This study provides evidence that adherence to surgical antimicrobial prophylaxis guidelines increased the rational use of prophylactic antibiotics, with substantial cost savings in patients who underwent surgery.
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http://dx.doi.org/10.2147/IDR.S212728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689569PMC
August 2019

Outcomes of Implementation of Sacral Nerve Stimulation in Incontinent Patients in Shiraz.

Adv Biomed Res 2019 20;8:21. Epub 2019 Mar 20.

Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Fecal incontinence is a common disorder in old age; however, it may not threaten life, but it can cause morbidity and many problems. Sacral nerve stimulation (SNS) is a minimally invasive surgical procedure performed by chronic electrical stimulation of the nerves in the sacral plexus through a lead implanted at the S3 foramen. This study aimed to evaluate the outcomes of SNS in Shiraz.

Materials And Methods: Data from patients who underwent implantation of an SNS device from 2012 to 2018 were reviewed in Shiraz. Thirty patients who had incontinence were evaluated by a committee. Pre- and postoperative assessments of the severity of incontinence were performed using Wexner Incontinence Score. Statistical analysis was performed using paired -test.

Results: Twenty-seven patients proceeded to insertion in the temporary SNS, and of these, 16 were elected to have a permanent SNS. Finally, seven patients were satisfied with their treatment. There was a significant reduction in the pre- and post-SNS Wexner Incontinence Scores from a median of 15-10, respectively ( < 0.05).

Conclusion: In our study, 16 patients underwent SNS protocol, and 43.7% of them showed a good response and recovered. It is recommended as a method for the treatment of fecal incontinence. Permanent SNS is effective, showing a significant improvement in fecal incontinence scores.
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http://dx.doi.org/10.4103/abr.abr_202_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446578PMC
March 2019

Effects of Stapled Hemorrhoidopexy on Anorectal Function: A Prospective Randomized Controlled Trial.

Iran J Med Sci 2018 Nov;43(6):581-586

Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Stapled hemorrhoidopexy is a safe and acceptable alternative to traditional hemorrhoidectomy with shorter hospital stay, better satisfaction, and less postoperative pain. There have, however, been reports on early and late complications. Therefore, the present study was designed to assess the impact of stapled hemorrhoidopexy on anorectal function and continence.

Methods: Sixty-one patients with rectal prolapse and/or symptomatic circumferential hemorrhoidal disease, as validated by the Wexner incontinence score, were included. Anal manometric indices were measured. The Wexner scores and anal manometric measures were compared pre- and postoperatively using the Mann-Whitney U test. (A P<0.05 was considered significant.).

Results: Mean age was 46.8 years (range=18-80 y), with a mean follow-up time of 3 months. Fifty-one patients completed their follow-ups. For 45 patients with a Wexner score of 0 and no history of incontinence, the anal maximum squeezing pressure (AMD) was 125.3±43.1 mm Hg, the anal resting pressure (ARD) was 27.8±12.8 mm Hg, and the mean pressure was 40.0±16.8 mm Hg. The changes in the anorectal manometric indices before and 3 months after the operation were not statistically significant (P=0.99, P=0.55, and P=0.32, respectively). In 6 patients with Wexner scores of 1 or higher, the mean values of the AMD, ARD, and mean pressure not only decreased but also increased postoperatively, but the changes were not statistically significant (P=0.32, P=0.42, and P=0.45, correspondingly).

Conclusion: These data represent a series of patients with 3 months' follow-up after stapled hemorrhoidopexy and suggest that this technique is safe in experienced hands. It may have protective effects on anorectal function in patients with imperfect continent scores. IRCT2015101324504N1.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230943PMC
November 2018

Early Outcome of Patient with Ulcerative Colitis who Received High Dose of Steroid and Underwent Two Staged Total Proctocolectomy.

Adv Biomed Res 2018 30;7:11. Epub 2018 Jan 30.

Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Ulcerative colitis (UC) is an idiopathic inflammatory disorder. Currently, the final treatment is colectomy. The aim of this study was to investigate the outcomes of proctocolectomy in patients that used a high dose of prednisolone.

Materials And Methods: Seventy-five patients presenting for surgical management of histopathologically proven UC. All patients were offered total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). Patients were divided into two groups: low dose of steroids (Group A) and high dose of steroid (Group B) consumers. Data from these patients after 2 years were reviewed and analyzed.

Results: From total patients, 34 of them were male and 34 ones were female and seven patients underwent laparatomy. Overall incontinence rate was 8.8%; dysplasia was 22%, pouchitis was 18.9% while mortality was nil. The length of hospital stay was 6.76 days in Group A and 9.21 days in Group B ( = 0.399). Leakage was observed in nine of the patients after surgery ( = 0.589). Fecal incontinence between two groups was not statistically different ( = 0.063).

Conclusions: Laparoscopic TPC-IPAA is feasible in patients needing surgical management of UC. Preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.
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http://dx.doi.org/10.4103/abr.abr_175_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812099PMC
January 2018

Dual association of serum interleukin-10 levels with colorectal cancer.

J Cancer Res Ther 2017 Apr-Jun;13(2):252-256

Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Interleukin 10 (IL-10) is considered an immune modulator cytokine, showing both antitumor and pro-tumor characteristics. Its role in the pathogenesis and progression of colorectal cancer depends on microenvironmental milieu.

Materials And Methods: A case-control study with 58 newly diagnosed colorectal cancer (CRC) patients, and 30 healthy individuals was conducted to compare the serum IL-10 levels between patients and controls. Furthermore, the correlation of the cytokine levels with the pathological features and prognosis of the CRC was investigated. IL-10 levels in the sera of patients and controls were measured by Enzyme-linked immunosorbent assay.

Results: Mean serum IL-10 levels were significantly lower in CRC patients than in controls (P = 0.04). CRC patients with worse prognosis at the time of diagnosis tend to have higher levels of circulating IL-10 than those with better prognosis (P = 0.008). Receiver operating characteristics curve analysis demonstrated that IL-10 levels in the sera of CRC patients can be used as a prognostic biomarker in CRC patients (area under the curve = 0.71; P = 0.01).

Conclusions: Our results demonstrated a dual association of serum IL-10 levels in the initiation and progression of CRC. While lower IL-10 levels were associated with higher risk of the disease, its higher levels were associated with a poorer prognosis.
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http://dx.doi.org/10.4103/0973-1482.199448DOI Listing
April 2018

Practical Lessons from the Small Bowel Bleeding Lesions: A Case Report on Small Bowel Cavernous Hemangioma.

Iran J Med Sci 2017 Jan;42(1):108-110

Colorectal Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337759PMC
January 2017

Pulling Seton: Combination of mechanisms.

Adv Biomed Res 2016 19;5:68. Epub 2016 Apr 19.

Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Seton-based techniques are among popular methods for treating high type anal fistula. These techniques are categorized to cutting and noncutting regarding their mechanism of action. In this report we are about to describe a new technique, which is a combination of both mechanisms; we call it Pulling Seton.

Materials And Methods: In this technique after determining internal and external orifice of fistula, fistulectomy is done from both ends to the level of external sphincteric muscle. Finally, a remnant of fistula, which remains beneath external sphincteric muscle is excised, and Seton is passed instead of it and tied externally. After the wound heals, patient is asked to pull down the Seton for 3-4 min, 4 times a day. We prospectively enrolled 201 patients with high type anal fistula in this study.

Results: Seton gradually passes through external sphincteric muscle till it is displaced outwards or removed by a surgeon via a small incision. 94% of patients treated by this method accomplished their treatment completely without recurrence. None of the patients developed permanent fecal or gas incontinence. Only 5% of patients developed with recurrence of fistula. Since Seton traction is not permanent in this technique, Seton cuts external sphincter slowly, and minimal rate of incontinence is reported.

Conclusion: Pulling Seton seems to be an efficient way in treating high type anal fistula with minimal rate of recurrence and complications such as incontinence and authors suggest further randomized studies to compare its efficacy with other Seton-based techniques.
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http://dx.doi.org/10.4103/2277-9175.180637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854033PMC
May 2016

Efficacy of Biofeedback Therapy before and after Sphincteroplasty for Fecal Incontinence because of Obstetric Injury: A Randomized Controlled Trial.

Iran J Med Sci 2016 Mar;41(2):126-31

Colorectal Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Unlabelled: Fecal incontinence is a challenging condition in that it exerts various psychosocial impacts on daily life. Different treatment modalities have been suggested for fecal incontinence. The present study aimed to evaluate the efficacy of biofeedback therapy in combination with surgery in the management of fecal incontinence. The present randomized controlled trial was performed on 27 women with a complaint of fecal incontinence because of delivery trauma. The patients underwent sphincteroplasty and levatorplasty via the same method by 2 colorectal surgeons. In Group I, biofeedback therapy was performed 3 months before and 6 months after the surgery; in Group II, biofeedback therapy was applied only 6 months after the surgery; and in Group III, only surgical management was performed. The results revealed a significant difference between the preoperative and postoperative Wexner scores of incontinence in all the 3 groups. Additionally, the difference between the preoperative and postoperative scores was significant only in Group I and Group III, but not in Group II. The reduction in the Wexner score was significantly less in Group III. However, no significant difference was observed between the 3 groups concerning the mean difference of preoperative and postoperative manometry. The present study revealed no significant role for biofeedback therapy alone in the improvement of manometric evaluation. However, the Wexner score, which is an indicator of patient satisfaction, increased with biofeedback therapy following sphincteroplasty. In general, surgical treatment is now reserved for selected patients with fecal incontinence and has recently been developed with biofeedback therapy.

Trial Registration Number: IRCT201206039936N1.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764962PMC
March 2016

How the anal gland orifice could be found in anal abscess operations.

J Res Med Sci 2015 Jan;20(1):22-5

Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time.

Materials And Methods: In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2%) and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening.

Results: The internal orifice was identified in 44 out of 49 patients (90%) who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess.

Conclusion: Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354060PMC
January 2015

Gastrointestinal basidiobolomycosis accompanied by liver involvement: a case report.

Iran Red Crescent Med J 2014 Sep 17;16(9):e14109. Epub 2014 Aug 17.

Transplant Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran.

Introduction: Basidiobolomycosis is a rare disease that, unlike other fungal infections, affects immunocompetent individuals. It is caused by an environmental saprophyte named the fungus Basidiobolus ranarum. Basidiobolomycosis usually appears as a subcutaneous infection. GI basidiobolomycosis is an emerging disease, and the colon is the most frequent involved part of the GI tract.

Case Presentation: The present study presents a middle-aged lady suffered from basidiobolomycosis with concomitant lesions in the cecum and liver involvement. This disease is extremely rare in adults and only a few cases have been reported so far.

Conclusions: GI basidiobolomycosis is a very rare disease which resembles as an infiltrative, infectious, or inflammatory process. Concomitant liver and bowel involvement is extremely rare too. It is an aggressive disease which has a high mortality rate despite treatments like surgical resection and prolonged antifungal therapy.
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http://dx.doi.org/10.5812/ircmj.14109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270646PMC
September 2014

Large small cell carcinoma of anorectal canal.

Arch Iran Med 2014 Mar;17(3):204-6

Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Neurofibromatosis type-1 (NF1), also known as Von Recklinghausen disease, is an autosomal dominant disorder with incidence of one per 4000. Neurofibromas are benign, heterogeneous, peripheral nerve sheath tumors coming up from the connective tissue of peripheral nerve sheaths, particularly the endoneurium. Visceral involvement in disseminated neurofibromatosis is considered rare. Neurofibroma occurs most frequently in the stomach and jejunum, but colon and anorectal canal may also be involved. Gastrointestinal neurofibromas may lead to bleeding, obstruction, intussusception, protein-losing enteropathy and bowel perforation. We encountered a case of diffusely involving the anorectal area by huge neurofibroma, which resulted in pelvic pain with watery diarrhea and urgency.
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http://dx.doi.org/0141703/AIM.0012DOI Listing
March 2014

Hypoglycemia, the first presenting sign of hepatocellular carcinoma.

Saudi Med J 2006 Mar;27(3):387-8

Department of Surgery, Faghihi Hospital, Shiraz, Iran.

Hypoglycemia is a well-known paraneoplastic manifestation of hepatocellular carcinoma usually occurring in the terminal stages of the disease. However, during initial presentation this manifestation is uncommon. We report a 77-year-old man who presented with signs and symptoms of severe hypoglycemia for example drowsiness. After clinical work-ups, we detected a large mass in the liver. Interestingly, after surgical excision of the tumor, the attacks of decreased level of consciousness and hypoglycemia seized.
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March 2006

Assessment of electrotherapy in treatment of hemorrhoids in Southern Iran.

Saudi Med J 2004 Dec;25(12):1896-9

Division of Colorectal Surgery, Department of Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, PO Box 71345-1853, Shiraz, Iran.

Objective: In this study, we have developed an electrotherapy device in order to improve the outcome and decrease the number of referrals and duration of treatment of internal hemorrhoid.

Methods: We treated 2015 hemorrhoids among 931 patients (382 males and 549 females); 319 hemorrhoids were grade 1, 1158 grade 2 and 538 grade 3, from May 1995 to October 2002, at Nemazee and Faghihee Hospitals in Shiraz University of Medical Sciences, Shiraz, Iran. All patients were referred due to fresh rectal bleeding or reducible prolapsed hemorrhoid with no response to medical treatment. After introduction of anesthesia, 27-30 mAmp direct current was applied to each hemorrhoid with durations of 4.5 minutes for grade 1, 5.5 minutes for grade 2 and 7 minutes for grade 3.

Results: Our results showed that 97.1% of patients responded well to the treatment and 27 patients returned with fresh rectal bleeding or prolapsed hemorrhoid in 2 weeks to 2 months postoperatively. Ninety-six percent of the patients were discharged on the same operating day. After 24 hours postoperation, 92% of the patients had no any pain and no need any analgesic. Among those patients who had not responded to the treatment; 24 cases underwent electrotherapy for a 2nd time and 3 patients were treated excising their prolapsed hemorrhoids. No other complications were detected.

Conclusion: Postoperative pain was mild and tolerable and 93.2% of patients returned to normal activity after 2 days. Electrotherapy with the above mentioned method is considered safe and effective without any major complications and with acceptable patient's satisfaction. This method can be used for treatment of grades 1, 2 and 3 hemorrhoids.
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December 2004
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