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Atlantoaxial rotatory subluxation [AARS] is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging [MRI]. However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation [Harms technique] with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient
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Objective: To investigate the determinants of outcome in patients with traumatic brain injury [TBI] undergoing decompressive craniectomy [DC] in a large level I trauma center in southern Iran
Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in Shahid Rajaei hospital, a Level I trauma center in Southern Iran. Patients with TBI who had undergone DC were included and the medical charts were reviewed regarding demographics, clinical, radiological and outcome characteristics. The outcome was determined by extended Glasgow outcome scale [GOS-E] after one year of surgery. The variables were compared between those with favorable and unfavorable outcome to investigate the outcome determinants
Results: Overall 142 patients with mean age of 34.8+/-15.5 [ranging from 15 to 85] years were included. There were 127 [89.4%] men and 15 [10.6%] women among the patients. After 1-year, the mortality rate was 58 [40.8%] and 8 [5.6%] patients were persistent vegetative state. The final outcome was found to be unfavorable in 77 [54.2%] patients. Unfavorable outcome was associated with lower GCS on admission [p<0.001] as well as occurrence of postoperative hydrocephalus [p=0.011]. Formation of the postoperative subdural hygroma after the operation was found to be associated with favorable outcome [p=0.019]
Conclusion: DC in patients with TBI is associated with favorable outcome in most of them. On admission GCS, postoperative hydrocephalus and presence of postoperative subdural hygroma are among the important predictors of outcome in TBI patients undergoing DC
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Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture
Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult [>18 years] patients suffering from long bone [Femur, Tibia, Humerus and Ulna] non-union fracture who were randomly assigned to receive 5mL PRP [n=37] or 5mL normal saline as placebo [n=38] in the site of fracture after intramedullary nailing or open reduction and internal fixation [ORIF] along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up
Results: The healing rate was significantly higher in PRP group compared to placebo [81.1% vs. 55.3%; p=0.025]. The limb shortening was significantly higher in those who received placebo [2.61 +/- 1.5 vs. 1.88 +/- 1.2mm; p=0.030]. Injection of PRP was also associated with lower pain scores [ p=0.003] and shorter healing duration [ p=0.046]. The surgical site infection [ p=0.262] and mal-union rate [ p=0.736] were comparable between groups
Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application
Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry [IRCT201208262445N1; www.irct.ir]
ABSTRACT
Deep vein thrombosis [DVT] and pulmonary embolism [PTE] are known as venous thromboembolism [VTE]. DVT occurs when a thrombus [a blood clot] forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury
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Objective: to determine the effects of application of anti-adhesive films [OrthoWrap[TM]] in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty
Methods: this was a retrospective cohort study being performed in ShahidRajaei hospital [Shiraz Level I trauma center] during a 12-month period [from March 2012 to April 2013] including 93 patients undergoing traumatic decompressivecraniectomy.Patients who received OrthoWrap[TM] during the initial craniectomy [n=44] were compared to those who did not [n=49]. Two study groups were matched regarding the baseline characteristics. The perioperative indices including the surgical time, amount of bleeding, transfusion and 6-month Glasgow Outcome Scale [GOS] were compared between two study groups
Results: there was no significant difference between two study groups regarding the baseline characteristics. We found that the cranioplasty duration [113.3 +/- 33.2 vs. 146.9 +/- 34.9 minutes; p<0.001] and amount of intraoperative bleeding [182.1 +/- 98.3 vs. 270.6 +/- 77.6 mL; p=0.043] was significantly lower in those who had OrthoWrap[TM] compared to control group. The final GCS [p=0.052] as well as GOSE [p=0.653] was comparable between groups. The infection rate was comparable between two study groups [p=0.263]
Conclusion: application of OrthoWrap[TM] during decompressive craniectomy in those with severe traumatic brain injury is associated with shorter duration of operation and less intraoperative bleeding in subsequent cranioplasty. Infection rate and neurologic outcome was comparable between study groups
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Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran
Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients' characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment [non-operative or operative] and clinical outcome. The data were described and compared with the international literature
Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury [with or without spine cord injury] was confirmed in 206 patients. The mean age of patients was 37.2 +/- 15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 [29.1%] patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31[15.1%] patients. Open surgery was performed in 65[31.6%].Mortality rate was 7.3% [15 patients].Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury
Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 [10%] cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group
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Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery [ECA] aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury [TBI] following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure [ICP] monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy
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Objective: To investigate the effects of intracranial pressure [ICP] monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury [TBI]
Methods: This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period [from 2006 to 2010] including those patients with severe TBI who had undergone care based on ICP monitoring [case group] or clinical evaluation [control group].Patients and controls were matched regarding the age, sex, initial GCS, initial pupils, and CT findings. The functional outcome, complications and mortality rate were recorded and compared between those who underwent ICP monitoring and those who did not
Results: There was no significant difference between two study groups regarding the baseline characteristics. The rate of meningitis was significantly higher in those who underwent Ventriculostomy and ICP monitoring when compared to those who were managed without ICP monitoring. [14 [23.3%] vs. 7 [11.6%]; p=0.041]. We found that the mortality rate [28.3% vs. 11.6%; p=0.172] as well as the frequency of persistent vegetative state [5.0% vs. 5.0%; p=0.998] were comparable between two study groups. However the frequency of severe disability was higher in control group compared to case group [26.7% vs. 15.0; p=0.046]. In the same way, the frequency of good recovery [26.7% vs. 15.0; p=0.046] and favorable outcome [51.7% vs. 33.3%; p=0.021] was significantly higher in case group
Conclusion: Care based on ICP monitoring in patients with severe TBI was associated with increased frequency of good recovery and favorable outcome and decreased frequency of moderate disability. However higher meningitis rate was associated with Ventriculostomy and ICP monitoring
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Syringobulbiais very rare condition defined as slit-like fluid cavity in the brain stem. Several conditions have been reported to be associated with syringobulbia including neoplasms, spinal cord traumas or lesions such as tethered cord, hind-brain herniation, infections such as meningitis and in isolation. Although post-traumatic syringomyelia has been wieldy described previously, traumatic brain injury has not been reported as the mechanism and etiology of isolated syringobulbia. We herein report a 24-year old man with previous history of severe traumatic brain injury who presented with recent onset inability to walk or coordinate movements, ataxia, dysphonia, dysarthria, bilateral third nerve palsy with fixed dilated pupils and eyes deviated outward and downward. He was further diagnosed to have isolated syringobulbia extending to upper pons and lower midbrain. Isolated post-traumatic syringobulbia is extremely rare condition presenting insidiously with cranial nerve palsies, ataxia and dysarthria
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To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months [September 2007 to September 2008]. The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients. Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery [19.64%] the general surgery was the busiest discipline in emergency operations [59.14%]. Appendectomy [11.77%], double/triple lumen/central venous catheter insertion [9.4%], and fiber optic/rigid bronchoscopy [3.27%] were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation [10%]. Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents
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Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusionI [ACD/F]. A 65-year-old man with cervical spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage
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<p><b>OBJECTIVE</b>To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran.</p><p><b>METHODS</b>This study was conducted in Fars Province, Iran from November 22, 2009 to November 21, 2011. Victims'information consisted of age, sex, death toll involving dri- vers or passengers of cars, motorcycles and pedestrians, and site of injury etc. Accidents were analyzed in relation to hour of the day, season of the year, lighting condition including sunrise, sunset, daytime and nighttime.</p><p><b>RESULTS</b>A total of 3 642 deaths (78.3% were males, and the ratio of males to females was about 3.6:1) were studied regarding their autopsy records. There was a steady increase in fatal accidents occurring at midnight to 15:59. The risk of being involved in a fatal traffic accident was higher for those injured between 4:00 to 7:59 than at other times (OR equal to 2.13, 95% CI 1.85-2.44). The greatest number of fatal RTAs took place in summer. Mortalities due to RTA during spring and summer were more pronounced at 20:00 to 23:59 and midnight to 3:59, whereas mortalities in fall and winter were more pronounced from 12:00 to 15:59.</p><p><b>CONCLUSION</b>The high mortality rate of RTA is a major public health problem in Fars Province. Our results indicate that the time is an important factor which contributes to road traffic deaths.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Accidents, Traffic , Mortality , Iran , Epidemiology , Time FactorsABSTRACT
BACKGROUND/AIMS: Metabolic syndrome is a well-known risk factor for atherosclerosis. Non-alcoholic fatty liver disease (NAFLD) has features of metabolic syndromes. This study aimed to investigate the association between NAFLD and atherosclerosis. METHODS: In a population-based study in southern Iran, asymptomatic adult inhabitants aged more than 20 years were selected through cluster random sampling, and were screened for the presence of fatty liver and common carotid intima-media thickness (CIMT), with abdominal and cervical ultrasonography, respectively. Those with fatty liver were compared to the same number of individuals without fatty liver. RESULTS: Two hundred and ninety individuals were found to have fatty change on abdominal ultrasonography, and were labeled NAFLD. Compared to normal individuals, NAFLD patients had significantly higher prevalence of increased CIMT (OR, 1.66; p<0.001). Those with hypertension (HTN), diabetes mellitus (DM), higher waist circumference (WC) and older ages had significantly higher prevalence of thick CIMT. Through adjusting the effects of different variables, we indicated that NAFLD could be an independent risk factor for thick common carotid intima-media (OR, 1.90; 95% CI, 1.17-3.09; p=0.009). It was also shown that age could be another independent risk factor for thick CIMT. CONCLUSIONS: Individuals with risk factors such as HTN, DM, and high WC are prone to develop atherosclerosis of the carotid artery. The presence of NAFLD should be considered as another probable independent factor contributing to the development of carotid atherosclerosis.