[Comparison of the diagnostic value of the gray scale and color Doppler ultrasonography in the diagnosis of solid breast masses]

Breast masses are considered as a common problem in women and early diagnosis of breast masses by radiologic techniques can reduce mortality rate of breast cancer about 20-30%. The aim of this study was to compare the diagnostic value of the gray scale and color Doppler ultrasonography in the diagnosis of solid breast masses. This was a diagnostic value study and included 93 female patients with breast solid masses who had referred to pathology ward of Imam Reza Hospital for FNA. Color doppler ultrasonography was performed for all the patients before biopsy. Then the results of ultrasonography and pathology were collated with each other. Data were introduced in to SPSS 20 software and analyzed by statistical tests and diagnostic value analysis. The sensitivity of 8 indices of color Doppler ultrasonography and gray scale i.e, mass flow rate, RI, PSV, EDV, tumor size, irregular margin of the masses, ENH and the mass shadow were%63,%100,%35, 100%,%26,%89, 0 and%15 respectively. According to the results of this study the diagnostic values of vascular tumors, tumor margins, RI and EDV values are significant for the diagnosis of malignant tumors and can be used as predictors of the status of the breast tumors

Experience of cyclone Gonu in the Islamic Republic of Iran: lessons learned

Gonu, the second tropical cyclone of the 2007 northern Indian ocean cyclone season, affected Oman, Pakistan, the United Arab Emirates and the Islamic Republic of Iran. This report examines the effects of cyclone Gonu in the Islamic Republic of Iran where it approached on its path on 6 June 2007 and reviews the actions taken before, during and after the cyclone. The incident highlighted the need for a special protocol to be prepared for all types of natural disasters. Responsible organizations should train their personnel according to the prepared protocols and service packages. Among the important lessons learned were the need for early warning, proper community involvement, access to essential data for risk analysis, special attention to safety of infrastructures, coordination and command integrity

[Causes and severity of fatal injuries in autopsies of victims of fatal traffic accidents]

In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from 2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle [car, motorcycle, autobus or minibus], consciousness level, and intensive care unit [ICU] admission was gathered. For evaluation of injury severity, we used Injury Severity Score [ISS]. The population under study consisted of 202 men [80.5%] and 49 women [19.5%] with an average age of 34.1 years [range 1-89 years]. Motorcycle-pedestrian accidents were the most common type of injury [100, 39.8%]. Head [220, 87.6%] and face [169, 67.3%] were the two most common sites of injuries. Mean [ +/- SD] of ISS was 23.2 [ +/- 10.4]. According to autopsy records, the main cause of death was head trauma [146, 58.1%]. Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents

Diaphragmatic perforation without penetration into the peritoneum in sharp thoracoabdominal injury

In diaphragm injuries, especially those which are left sided, it is recommended to repair diaphragm perforation to prevent complications. However, we found two cases of diaphragm injuries including two 27 and 31 years old men who were injured with stab but they were not repaired at thoracoscopy. Both patients were haemodynically stable. Chest X-ray and CT-scan were not in favor of diaphragm perforation in both cases. The thoracoscopic finding was a 1.5 [case 1] and 1 cm teasing on the left diaphragm on the left muscular past of the diaphragm without penetrating into the abdominal cavity and with an intact peritoneum documented by probing. Due to intact peritoneum and absence of peritoneal signs, no further thoracotomy was performed. The patients were followed for 6 months with CXR and also physical examination. They did not develop any complication on the follow-up. In conclusion, in spite of diaphragm injuries, since peritoneum was intact in both cases, neither underwent thoracotomy which is invasive. They were asymptomatic during the 6 months of the follow up

Road Traffic Crashes Mortality and Morbidity in Iran in 1997- 2006

Road traffic crashes are the main cause of trauma mortality in most of world countries especially Iran. The objective of this study is to evaluate R TC mortality and morbidity in the last 10 years [1997-2006]. Data were obtained from Iran official reports of police, health sources and the Statistical Centre of Iran [SCI]. These data include population, registered motor-vehicles number, RTC, RTC injuries and deaths, during the period of 1997-2006. Statistical analysis was. performed by State 8 software and significance of mortality change was evaluated by Poison distribution. RTC fatalities increased between 22.1 [95%CI, 21.7-22.4] per 100, 000 and 40.5 [95%CI 40.1-41.0] per100, 000 from 1997 to 2005, but in the last year of 2006, this trend is reversed and there was declined to 39.1 [95%CI, 38.7-39.6] per 100, 000. R TC injuries has been increased from 110 to 401 per 100000 population from 1997 to 2005, but decreased to the 393 per 100000 in 2006. This paper shows road traffic crashes mortality and mortality in Iran in recent ten years and the decrease in the last year. This decline was most probably the result of a variety of interventions, including legislation, police enforcements improvements in traffic and transport, health care facilities and media and public education. It is recommended that efforts of all responsible organizations continue in unique leadership

[Assessment of the role of prevention training and care in trauma patients in rural regions 2001-2005]

Trauma-related mortality [due to road accidents and gunshot and disaster...] is unexpectedly high in Iran. Short trauma care training course to rural health system and villager of Mehran, Eylam would improve the care for trauma victims. The objective of the present study is to describe the training and evaluate its effect using changes in physiological function of victims. Advanced trauma care course for physicians and nurses, complementary basic trauma care course for emergency technicians and health workers, basic trauma care for highly educated people and first aid short course for ordinary people were developed. After training, the region traumatic patients entered the system through two channels: to the local Mehran Emergency Clinic [some with primary treatment before the local emergency clinic] or directly to Ham University Hospital. Outcome indicator was the physiological change assessed with the physiologic severity score [PSS]. During courses period, 185 physicians and nurses, emergency technicians and health workers, 239 highly educated people and 4410 ordinary people were trained for trauma care. During 3 years leater 366 injured were transported to Mehran Emergency Clinic [226 received primary treatment before the local emergency clinic] and 245 were admitted directly to Ham University Hospital. Total mortality rate was 10.3 percent [66 out of 641 injured people] and the mine injured mortality rate was 20.7% [37 out of 179 mine injured]. In the injured who received trauma care at Mehran Emergency Clinic, PSS mean was 6.4 which improved to 7.5 in the hospital [P<0.001] in comparison with 6.79 in the other group. Rural health worker and general population could be upgraded to care for victims of injuries by using available resources. This system can improve the indicators and reduce trauma mortality rate

Reduced incidence of early complications of surgical wounds in laparoscopic surgery

Wound-related complications are major sources of trouble in post-operative period and slow down the wound healing process. This study was performed to determine the incidence of early wound related complications in laparoscopic versus open abdominal surgeries. Medical records of 104 elective laparoscopic [A] and 106 diagnosis matched open surgeries [B] including appendectomy, cholecystectomy, ventral hernia repair, and bariatric surgery were retrospectively reviewed between Jun 2002 and Jan 2005. Study data included patients' sex, age, wound class, type of operation, and occurrence of early wound related complications. Surgical wounds were evaluated for presence of early complications during the post-op period and 10 to 15 days after the operation. The two groups were not different regarding age, sex and wound classes. Wound infection developed in 7 patients [RR: 0.06 [0.01-0.77] [95%CI]] and none in patients of group B. Incidence of Hematoma was similar in the two groups; one case in each. No patients in the two groups experienced seruma nor wound dehiscence. Gender, age, and wound classes were not associated with higher rates of wound complications. Laparoscopic surgery significantly reduced the incidence of early wound complications, namely wound infection, and is a safe and efficient alternative to conventional open procedures

Open lung biopsy with local anesthesia

Open lung biopsy may be required in the patients with parenchymal lung disease who do not have a clearly defined diagnosis. There is no doubt thoracotomy with general anesthesia is preferable to local anesthesia; but it is associated with high risks in the severally ill patients. The aim of this study is to review our experience and compare the efficacy and complications of using local anesthesia versus general anesthesia for open lung biopsies in high risk patients. From January 2002 to September 2004, Twenty five patients [18 males, 7 females] underwent open lung biopsy using minithoracotomy in the Baqiyatallah hospital in Tehran. 14 [56%] of them had open lung biopsy using general anesthesia [GA] and 11 [44%] selected for this procedure with local anesthesia [LA], all of LA group were excluded from GA because of their poor condition. we reviewed effectiveness of LA for minithoracotomy and also compared the safety, accuracy and various complications of this procedure between the two methods of anesthesia. The mean age in the first [GA] group was 42.5 [ +/- 14.7] years and in the second [LA] group was 49.6 [ +/- 12.2] years [NS]. The average length of hospital stay, postoperative air leak, and the diagnostic accuracy was not significantly different between the two groups. There was one operative-related mortality in the second group [NS]. In selected patients with diffuse lung disease or peripheral lesions Local anesthesia is an acceptable substitute to general anesthesia for minithoracotomy to obtain adequate lung tissue for accurate diagnosis

Result and complication of vertical banded gastroplasty in morbid obesity

Vertical Banded Gastroplasty [VBG] is a method to reduce the stomach volume, which causes weight loss through lowering amount of consuming solid foods. This operation consists of implanting a small pouch in the proximal of the stomach and a tight exit area. This study was made to evaluate the efficacy and complication of VBG in the treatment of morbid obesity. The present practical study is prospective clinical experience without control group who was carried out between year 1376 and 1381. Of total 30 patients; 21 [70%] females and 9 [30%] male who underwent [VBG] in Baqiyatallah hospital. The averages of age was 32.87 +/- 8.12 years, height 168.66 cm, weight 130.70 +/- 19.33 Kg and BMI 45.53 +/- 10.15 kg/m[2]. The indication of surgery was BMI >40 or BMI = 35-40 with co-morbid illness. Seventy percent of patients complained from a symptom due to excess weight and co-morbid illness [diabetes, high blood pressure, cardio-pulmonary problems]. Duration of hospitalization in the patients in the groups without early complication was 9.7 days and the average follow up was 24 months [range 2-72 months]. Weight loss in the first month after surgery was 11.03 +/- 2.48 and after first year was 41.38 +/- 10.93. The average decrease in BMI at the end of study was 10.45 kg/m[2]. 66.7 percent of the patients did not show any post-operative complication. One of the patients had pulmonary emboli [3.3 percent], one wound infection [3.3 percent], one GI bleeding [3.3 percent] and 2 patients had peritonitis [6.6 percent]. Regarding delay complication, there was one case of intestine obstruction [3.3 percent] and 6 cases of incisional hernia [20 percent]. One of the patients died due to hypovolumic shock [3.3 percent]. This study showed that amount of loss of weight following a VBG operation was significant and also, it was found that amount of loss of weight in male was significantly more than female [P=0.020]. Among the excess weight associated disease, it was only respiratory problems, which had a significant relationship with post surgery complication [P=0.026]. In the meantime, three was no significant relationship between age, weight, sex and BMI with regard to postoperative complication