Hydatid cyst caused by Echinococcus granulosus usually involves lung and liver but can appear in other organs. We report a 29-yr-old woman presented to Fatemi Hospital, Ardabil, Iran in 2017 with progressive painful swelling of the left gluteus which in imaging showed hydatid cyst. The cyst was successfully en blocked and the patient was discharged on albendazole treatment with no recurrence in the symptoms during the first week, first and second months after surgery follow-up and in the final visit at third months. In the endemic regions, the possibility of hydatid cysts should be considered in differential diagnosis of any cystic mass.

Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects. Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC. Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant. Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001). Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

HighlightsHydatid cysts primarily involve the liver and lung.Hydatid cysts could be presented in any site of the body including the muscles which is very rare.Hydatid cyst was observed as growing mass in the biceps femoris.Hydatid cyst should be considered as differential diagnosis of any growing mass or cyst in the body in the endemic areas.

Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients.

Background & objectives: Trauma is one of the most common causes of death in the age range 1 to 44 and the third cause of death regardless of age. Abdominal trauma is one of the most common types of trauma. This study aimed to investigate the frequency of causes of laparotomy in penetrating and blunt abdominal traumas in 2016. Methods: This descriptive study was conducted on 120 medical records of patients hospitalized for penetrating and blunt abdominal traumas in Fatemi Hospital, Ardabil, 2016. The inclusion criterion consisted of all patients undergoing laparotomy due to abdominal trauma. In this study, age, gender, education level, type of trauma (blunt or penetrating), results of laparotomy surgery, physical examination and paraclinical findings of patients before operation were collected by a researcher-made checklist. Results: The results showed that 80% of the patients were male and 35% were in the age range 20-29years. Of patients, 38.3% had penetrating trauma and 61.7% blunt trauma. The most common mechanism of blunt abdominal trauma was car accident (83.8%). Penetrating object was the cause of all penetrating abdominal traumas. Peritoneal stimulation symptoms were observed in 56.5% of penetrating abdominal traumas and 62.2% of blunt abdominal traumas. Hypotension was observed in 21.7% of patients with penetrating abdominal trauma compared with 62.2% in patients with blunt abdominal trauma. The most prevalent damaged organ in patients with blunt trauma was spleen (51.4%). The most prevalent damaged intraabdominal organ was small bowel (17.4%). Negative laparotomy was significantly higher in patients with penetrating trauma than those with blunt trauma (p<0.0001). Moreover, 9.2% of all patients had died and mortality rate was higher in patients with blunt trauma than penetrating trauma (p<0.05). Conclusion: The results of this study showed that: 1. Road traffic accident and penetrating object were the most common causes of laparotomy in patients with blunt and penetrating trauma respectively; 2. Spleen and small bowel were the most prevalent damaged organs in blunt and penetrating abdominal trauma respectively and; 3. Young males were at highest risk of abdominal traumas.