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Aspiration pneumonia is a critical disease and can result from a various causes. Epiphrenic diverticula is a rare disorder, which can cause aspiration of food material contained in it. Mediastinal tuberculosis can also cause traction diverticula at mid-esophagus, which usually are asymptomatic and induce no complication. In this article we describe a case, suffering of all these three disorders and after seven years of surgery and medical treatment any symptom was not found in the patient.

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Background and Objective: Abdominal operations as gynaecological procedures result in gastrointestinal dysmotility. Early feeding and ambulation are nonpharmacologic interventions which can be useful in re-initiation of bowel function. This study was done to evaluate the effect of early oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women.

Materials and Methods: In this randomized clinical trial, 120 primiparous women undergone elective cesarean section were assigned to control and intervention groups in Hajar hospital, Shahrekord, Iran during 2007. In the interventional group, oral hydration with liquids was started 4 hours after surgery regardless of presence of bowel sounds and solid food was started after bowel sounds appeared. The control group recieved liquid diet 12 hours after the operation if it was tolerated, they were given soft diet and regular food at the next meal. The return of bowel activity, time of ambulating, satisfaction, discharge from the hospital and complications were compared in two groups. The data were analyzed using SPSS-15, Chi-Square, T and one way ANOVA tests.

Results: The mean postoperative time interval to first hearing of normal intestinal sounds in interventional versus control groups were (9.5±1.38 and 12.5±2.5 hours) the first passage of flatus (15.7±3.61 vs.22.4±4.1 hours), time to first sensation of bowel movement (10.8±1.99 versus 15.7±3.4 hours) and defecation (18.9±3.65 versus 23.4±4.85 hours). These differences were significant (P<0.05). Also discharge from the hospital (0.96±0.18 versus 1.1±34 days) were significantly shorter in interventional group (P<0.05). The women in the early feeding group got out of bed (patient mobilisation) earlier than their interventional group (14.1 hours versus 18.8 hours (P<0.05). Maternal satisfaction was significantly higher among the early fed women (P<0.05).

Conclusion: Early oral hydration after elective cesarean section associated with rapid resumption of intestinal motility and increased woman’s satisfaction.

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Background and Objective: Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra abdominal organ injured more than others, related to mechanism of injury, size and location of organ in abdominal cavity. This study was carried out to determine the prevalence of intra abdominal injuries due to penetrating trauma. Materials and Methods: This retrospective descriptive study was done on 114 patients admitted to 5 Azar hospital in Gorgan, Iran due to penetrating abdominal trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitlalization period were obtained form patients files. Results: 92.1% of patients were male. The mean age of subjects was 24.8 years (9-70 years) with highest frequency between 20-24 years. Two (1.8%) deaths directly related to abdominal stab wounds related to hemorrhagic shock. The most common cause of penetrating abdominal injury was knife wound (78.9%). The mean time spent in hospital was 4.6±2.8 days. In 53 patients, cause of trauma were either related to pentration into peritoneum or passing through in. Small intestine injuries (14 %), rupture of diaphragm and concurrent lung injuries (7%) were the common damage organs. Conclusion: This study showed that the knife was the main cause of abdominal penetrate trauma and peritoneum was the most common damage tissue.

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Both fibrocystic change and phyllodes tumor are classified as fibroepithelial tumors of breast which are composed of epithelial and stromal components. Although as the most common benign breast lump fibrocystic lesions are known by symptom such as pain, nipple discharge, heaviness, usually in women’s third decade of life, mammographic and sonographic features often render them almost indistinguishable from phyllodes tumor. In view of the essential differences in terms of therapeutic planning which exist between these two tumors, their early and precise distinction is crucial to avoid problem such as patients’ anxiety and unwarranted tumors operation. In this article a case of fibrocystic change in a 24 year old woman is reviewed in which clinical signs and symptoms and mammographic changes are indication of phyllodes tumor.

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Background and Objective: There is not a general protocol strategy about the necessity of routine microscopic examination of tonsillar samples in children. This study was conducted to determine the histopathological characteristic of tonsillar tissue in 1250 children, Tabriz-Iran. Materials and Methods: This descriptive study was conducted on 1250 children (724 male and 526 female) aged 2-14 years old who underwent tonsillectomy in Tabriz, Iran during 2008-11. Variables including age, sex, clinical diagnosis and surgical indications were recorded. Paraffin blocks were prepared from samples of tonsillectomy and stained with haematoxylin and eosin. Histopathologocal results were categorized in four groups: Follicular hyperplasia, follicular hyperplasia with infection, malignancy and normal. Results: None of the children had initial clinical suspicion of tonsil tumor. Patients’ primary complaints were as follows: 92.5% mouth breathing, 93% nocturnal snoring, 74.3% recurrent and chronic cold and infections, 56.4% sore throat, 48.2% halitosis, 26% nocturnal apnea, 22.2% dysphasia, and 18.2% anorexia. Children with tonsillar hypertrophy and obstructive symptoms (57%), and tonsillar hypertrophy and recurrent infections (42.2%) underwent tonsillectomy. In the histopathlogical examination of all patients being hyperplasia together with lymphoid hypertrophy were observed and there was no evidence of malignancy in any of the patients. Conclusion: No instance of malignancy was found in the histopathological examination of children’s tonsil-removed tissues and all of the tonsils had benign hyperplasia with lymphoid hypertrophy.

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Background and Objective: Dissection of the axillary lymph nodes is considered as one of the common measures in management of breast cancer. Edema and limitation in hand movement are accompanied with dissection of axillary lymph nodes. Sentinel lymph node biopsy can be used to evaluate axillary metastasis. This study was carried out to evaluate the diagnostic value of sentinel lymph node biopsy in patients with breast cancer. Materials and Methods: This descriptive study was performed on 30 selected patients with breast cancer less than 5 cm without any involvement of axillary lymph nodes in Ghaem Hospital in Mashhad, North-East of Iran during 2009 -10. Initially, the lymphoscintigraphy was performed. Subsequently, prior, to the surgery, the blue dye as a marker was injected for detecting sentinel lymph node and with the use of probe gamma counter and observing blue color on lymph nodes, the sentinel node was determined and separated. Finally, axillary dissection was performed for removing the lymph nodes of I and II level in all patients. Results: Among 30 patients who were evaluated for sentinel lymph nodes and axillary dissection, false negative were observed only in two cases (6.6 %). The sensitivity rate was determined to be 84.6%. Conclusion: Considering the high success rate of detection of sentinel lymph node and limited false negative cases, sentinel lymph node biopsy is recommended in cases of breast cancer without axillary involvement.

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Background and Objective: Surgical wound infection is the most common complication following surgery. This study was done to determine the incidence risk factors of surgical wound infection following abdominal hysterectomy. Materials and Methods: This descriptive study was done on 400 patients who underwent abdominal hysterectomy in Babol, North of Iran, during 2008-10. Age, underlying disease, BMI, use of immunosuppressive drugs hospitalization period prior to surgery, shaving and bath time, prophylactic antibiotic, duration of surgery, diagnosis and pathology were recorded for each patient. Evidence of surgical location of infection including surgical discharge, erythema and dehiscence of surgical wound with and without fever during 10 days after surgery were recorded. Results: Surgical wound infection was seen in 26 patients (6.5%) following abdominal hysterectomy. Regression analysis determined, use of immune-suppressive (95% CI: 1.71-480.30, P=0.020, OR:28.70) and emergency operation (95% CI: 1.42-14.39, P=0.011, OR: 4.52), diabetes (95% CI: 1.23-11.26, P=0.020, OR:3.72) were risk factors for surgical wound infection. Conclusion: Immuno-suppressive agents, emergency operation and diabetes increased surgical wound infection in post- abdominal hysterectomy.

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Background and Objective: Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications. This study was carried out to assess the evaluation of clinical complications in morbid obese patients after modified jejunoileal bypass surgery. Method: This descriptive – analytic study was carried out on 120 morbid obese patients referred for bariatric surgery. A modified jejunoileal bypass was performed in which the defunctionalized organ eliminated by anastomosing its ends to the gall bladder and cecum. Weight loss and clinical complications were recorded after one year follow up. Results: The mean weight and body mass index reduced from 136 kg and 48 kg/m2 before surgery to 83 kg and 29/8 kg/m2 after one year follow up, respectively (P<0.05). Before surgery, articular pain (24.3%), dispana (21.6%), cardiovascular disorders (10.8%), fatty liver (5.4%) and sleep disorder (5.4%) due to obesity were recorded. One year follow up after surgery, articular pain (1.5%) and dispana (1.5%) were seen in patiants. No serious post-operative clinical complication was observed. Conclusion: One year follow up after surgery showed that the modified jejunoileal bypass is very effective in reducing body weight and does not lead to serious complication.

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Background and Objective: Foreign body ingestion is one of the most common problems in otolarygyology in the world. Many kind of foreign body is lodged in esophagus and cause symptoms and complication. Information about patient age and type of foreign bodies and symptoms can help in management and treatment of patients. This study was done to determine the Prevalence of esophageal foreign body and its complications in Gorgan, northern Iran.
Methods: This descriptive retrospective study was done on 145 patients (61 males and 84 females) with foreign body ingestion whom admitted in 5thAzar hospital in Gorgan, northern Iran during 2004-14. Age and type of foreign body and symptoms was recorded for each patient. X-Ray in 41.4% of patients detected foreign body and esophagoscopy in others were used for definitive diagnosis.
Results: Most common chief complaint was dysphagia (42.8%). The most common foreign body was chikenbone (25.5%). Under 15 year’s old patients, coine was the most common. Most common site of lodged was 1/3 upper esophagus (62.63%). In all causes rigid esophaguscopy was used for removal of foreign body. In 56 causes foreign body in esophagus had not any complication.Complications due to foreign bodies were erision (24.82%), ulcer (21.37%), rapture of mucosal layer (6.2%), recurrent refer (4.82%), perforation of esophagus (5 cases, 3.44%) and obsess esophagus(0.68%). Mortality was seen in one patient due to fish bone ingestion.
Conclusion: Dysphagia was the most common chief complaint and coine was the most common foreign body in children. Also, erision and ulcer were the most common complications and upper one third of upper esophagus was the most common site of lodged foreign bodies.

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Background and Objective: Trauma is the most important causes of lossing effective life in human comunities, and it is the second leading cause of death in Iran. This study was done to determine the pattern of penetrating injuries and intrathoracic organ damage in Gorgan, north of Iran.
Methods: In this descriptive study, data of 107 patients with penetrating injuries whom referred to
5th Azar hospital in Gorgan-Iran during 2016-17 were collected. Age, gender, job, type, location and cause of injury were recorded for eacgh subject.
Results: The mean age of patients was 26.13 years. The most frequent job was related to unemployed group (39.25%). The most freqent causes of trauma were quarrel with 78.5%. The most divice were knife with 66.35%. Lung was the most injured organ with 11.21%. The least damage was to the large vessels with one case (0.93%). The two patients died due to heart and subclavin vessels injuries.
Conclusion: This study showed that injury due to knife was the most prevalent of penetrating trauma in street strife in northern Iran.

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Late postpartum hemorrhage (PPH), as an unpredictable obstetrics emergency, is characterized as a leading cause of mortality and maternal complications worldwide. Uterine artery pseudoaneurysm (UAP) is a rare cause of PPH, which may develop after uncomplicated cesarean and Gynecologic surgeries, including dilatation and curettage, hysterectomy, and myomectomy. Uterine artery embolization has become a popular treatment for postpartum hemorrhage. In this case report, we present a patient with PPH due to UAP who was treated by endovascular embolization of the uterine artery. A 39-years-old woman was admitted 55 days after her third cesarean section due to massive vaginal bleeding resulting in severe hemodynamic derangements. After initial resuscitative measures, diagnostic studies revealed the UAP, and soon after, the coil embolization of the uterine artery was performed. When conservative managements fail to control massive late postpartum hemorrhage, angiography and embolization of the uterine artery can be the modality of choice, rather than hysterectomy (with its potential complications) which preserves the patient's fertility.