CMST

Pleural biopsy is a principal diagnostic evaluation of respiratory problems, especially in localized pleural disease, in which surgical exploration or prolonged clinical observation is inevitable. The new technology of flexible fiber optic endoscopic instruments for obtaining biopsies provides considerable resolution, facilitation and diagnostic accuracy, especially in malignancies. [1][2][3] To evaluate the efficiency and safety of flexible fiber optic pleuroscopy, 20 patients (75% male, mean age=57.9±14.1 years) with pleural effusion, who were hospitalized in the Department of Internal Medicine at Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences (2005)(2006) and required pleural biopsy for definite diagnosis were enrolled. The study was approved by the university Ethics Committee and informed consents were taken from all patients.

Various scoring systems are used to evaluate risks of surgeries, but an appropriate scoring system for predicting the post-surgical complications should not only be simple, easy to calculate, accessible in different hospitals and centers, and proper for various operations but also it must be able to precisely assess the complications under question. 1,2 The ASA scoring system developed in 1941 was reported to be an efficient system in predicting the mortality and to some extent morbidity rates in patients undergoing surgical operations. 3 Later on in 1977, the multi-factor Goldman Index was designed, aiming at predicting the prevalence of cardiac complications, and the major cause of post-operation mortality in noncardiac surgeries. This score is calculated, using the patient's age, history of underlying cardiac diseases, electrocardiogram findings, laboratory results and certain clinical observations. Several studies have assessed the efficacy of either scoring systems regarding the type of surgery performed. 2,4,5 There are controversial results regarding the efficacy of these systems in evaluating the operational risks. 6 The present study was, therefore, designed to assess the relationship between the patients' physical status considering ASA and Goldman scoring systems and the risk of developing complications or mortality following an open cholecystectomy surgery, one of the most common surgical operations usually performed on old individuals suffering from certain underlying complications with the objective of identifying the best scoring system in predicting the outcome of such an operation.

World Health organization (WHO) has reported that out of more than 10,000 of 250,000 tuberculosis afflicted children die annually. Pulmonary tuberculosis is a research priority in our country, and diagnosing this disease especially in children who are known as the major transmitter of the disease is rather difficult. As a result, it was decided to conduct an overall assessment on this age group in order to determine the importance of the findings of chest radiography and skin test in diagnosing the disease. The present descriptive study was carried out based on the findings of a health plan in Fasa , a Iranian town, during 1995 and 1996, on 2 groups: first-grade students of Fasa elementary schools. Among 2263 students, 102 (4.5%) cases had a positive skin test. According to the radiographic findings, tuberculosis was reported in seven (6.9%) of them. The diagnosis of tuberculosis is more difficult in children; this is because taking sputum samples for laboratory examination is rather difficult especially in children lower than 10 years. In this group, diagnosis is made based on the symptoms like cough, weight loss, history of contact with a TB patient and other diagnostic procedures including chest radiographies and skin test.

Background. The present study was carried out to evaluate the clinical characteristics and surgical methods used for the management of infected femoral pseudoaneurysms secondary to illegal drug injections. Methods. Fifty seven consecutive patients who presented with infected pseudoaneurysm of the lower limb and were admitted to the emergency department of Sina Hospital during a 5-year period were enrolled in this study. Surgical methods performed consisted of vein angioplasty, simple ligation of femoral artery, and emergent or delayed revascularization. Results. All participating patients were males with a mean age of 36.7 years. Three (5.3%) and two (3.5%) patients underwent primary repair and emergent vascular bypass, respectively; whereas delayed revascularization was performed in only eight (14%) cases. Forty four (77.2%) patients achieved a normal lifestyle without any vascular bypass. Early critical ischemia and late claudication was reported in two (3.5%) and eight (14%) patients, respectively. Other complications such as amputation and mortality were rarely reported. Conclusions. In our study, simple ligation of the external iliac or femoral artery was the most frequent management method for treating infected femoral pseudoaneurysms. Simple ligation of the external iliac or femoral artery seems to be a safe procedure in drug abusers presenting with infected femoral pseudoaneurysms. Ó 2008 IMSS. Published by Elsevier Inc.

Background: Morning report is considered as an important educational tool in different branches of medicine. The purpose of the present study was to examine the method of case selection, the leadership, the participant's satisfaction and the educational value of morning report held in our centre. Method: In September 2007, a formal feedback about the morning report was provided by questionnaire surveys. The data on the method of case selection, the leadership, the participant's satisfaction and the educational value of the sessions were collected from the residents, medical students and the academic staff in emergency medicine department. Each questionnaire also contained an open-ended question, asking for the responders' suggestions for improving these sessions. Results: 73.2% of the responders were satisfied with the current model of the conference hall. The data showed that 46.3% of the participants believed these sessions are held for giving the medical team the required information and 65.9% for solving the patient's problems. The data showed that the participants had evaluated the presentation strategy to be good; however, the presentation pattern was reported to be traditional and based on differential diagnosis in 53.7% of the cases and modern problem oriented in only 39%. Conclusion: Most participants considered morning report sessions held in our hospital to be effective in the way it is; however, issues such as communication skill, emergency department management, critical thinking, ethics, professionalism and evidence-based medicine should also be added to the sessions.

Purpose -The aim of this study is to compare the effects of Sanosil and glutaraldehyde 2 percent in disinfecting ventilator connecting tubes in an intensive care unit (ICU) environment. Design/methodology/approach -The 12-week open-labelled clinical trial was conducted in the surgical ICU of a teaching hospital from March to May 2005. In the first phase of the study, high level disinfection was performed using glutaraldehyde 2 percent, whereas Sanosil was used as the disinfectant agent of the second phase. Samples for microbial culture were obtained from the Y piece, the expiratory limb proximal to the ventilator and the humidifier in different stages; the results were then compared. Findings -Positive culture was more frequently reported in Y pieces, humidifiers and expiratory end of ventilators. Comparing the two groups, there were more positive cultures in the glutaraldehyde group (p value ¼ 0.005); multiple organism growths, gram negative, gram positive and fungi were also more frequent in this group (p value ¼ 0.01; 0. 007; 0. 062; 0.144, respectively). Originality/value -The paper shows that Sanosil is an effective agent in reducing the contamination risk in the tubes used in ICUs.

e Abstract-Background: Fireworks are the leading cause of injuries such as burns and amputations during the Persian Wednesday Eve Festival (Chaharshanbeh Soori). Objectives: This study was designed to explore the age of the high-risk population, the type of fireworks most frequently causing injury, the pattern of injury, and the frequency of permanent disabilities. Methods: This cohort study was performed by Tehran Emergency Medical Services at different medical centers all around Tehran, Iran, in individuals referred due to firework-related injuries during 1 month surrounding the festival in the year 2007. The following information was extracted from the patients' medical records: demographic data, the type of fireworks causing injury, the pattern and severity of the injury, the pre-hospital and hospital care provided for the patient, and the patient's condition at the time of discharge. In addition, information on the severity of the remaining disability was recorded 8 months after the injury. Results: There were 197 patients enrolled in the study with a mean age of 20.94 ؎ 11.31 years; the majority of them were male. Fuse-detonated noisemakers and homemade grenades were the most frequent causes of injury. Hand injury was reported in 39.8% of the cases. Amputation and long-term disability were found in 6 and 12 cases, respectively. None of the patients died during the study period. Conclusion: The fireworks used during a Chaharshanbe Soori ceremony were responsible for a considerable number of injuries to different parts of the body, and some of them led to permanent disabilities.

Introduction: Multiple endocrine neoplasia 2B, a rare autosomal dominant syndrome, is characterized by early onset of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and mucosal neuromas of the tongue, lips, inner cheeks and inner eyelids. Gangliomatosis of the gastrointestinal tract and its complications may also occur in patients with this disease. Case presentation: We present the case of a 16-year-old Persian man diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B (medullary thyroid cancer, mucosal neuroma of the tongue, lips and inner eyelids). Our patient, who had a positive family history of medullary thyroid cancer, was of normal height with no signs of marfanoid habitus. Conclusions: Ophthalmological and oral manifestations of multiple endocrine neoplasia 2B, as in the case of our patient, are rare presentations of the disease; unfortunately in the case of our patient his condition had not been noted and acted upon until he presented to our department. The diagnosis in our patient's case was made only after his mother presented with the same condition. As a result, we emphasize that physicians should pay more attention to the oral and ocular signs of multiple endocrine neoplasia 2B in order to diagnose this fatal syndrome at an earlier phase.

Background: General anesthesia and regional anesthesia have both been shown to be suitable techniques for patients undergoing lower thoracic and lumbar spine surgery; however, GA is the most frequently used method. The purpose of this study was to conduct an acceptable RCT to compare the intraoperative parameters and postoperative outcome after SA and GA in patients undergoing elective lumbar disk surgery. Methods: Patients undergoing laminectomy for herniated lumbar disk during the years 2005 and 2007 were enrolled. They were randomly selected to undergo GA and SA. The variables recorded during the operation were the patients' HR, MAP, amount of blood loss, and surgeons' satisfaction with the operating conditions. The severity of pain, nausea, vomiting, and length of stay in the hospital were recorded in the postoperative course. Results: The mean blood loss was less in the group undergoing GA; however, the difference was not statistically significant. The surgeon's satisfaction was reported to be higher in the GA group. No major intraoperative complication was reported in either series. During the recovery period, hypertension was reported to happen more frequently in the patients undergoing GA; and postoperative nausea and vomiting were more frequent among patients recovering from SA. Conclusion: Contrary to previous studies, the findings of the present study revealed that SA has no advantages over GA. Moreover, it was showed that GA can reduce the related risks and complications in several aspects.

Background. The survival of hemodialysis patients requiring dialysis depends on the long-term functioning and patency of the vascular access. Prosthetic vascular grafts are inevitably used for patients whose vessels are unsuitable for an autogenous arteriovenous (AV) fistula. The purpose of this study was to compare the patency rate and associated complications using different types of grafts. Methods. This prospective study was conducted on patients who did not have an appropriate vein for arteriovenous fistula from January 2004 through July 2006. They were divided into two groups, sex, age, and basic data matched. Polytetrafluoroethylene (PTFE) and polyurethane (PVAG) were the two types of grafts used in this study. The functionality of the graft was assessed immediately 1 day and 2 weeks after operation. The clinical follow-up was performed each 3 months until 24 months. Results. One-year patency rate was reported to be 64% and 52% in the PTFE and PVAG groups, respectively. There was no significant difference in 1-year (64% versus 52%) and 2-year (49% versus 41%) patency rate of the PTFE and PVAG grafts used as vascular access. There was also no difference between the numbers of complications reported in the two groups. Conclusion. It could be concluded that either PTFE or PVAG grafts can be used with the same expected outcomes.