Clinical characteristics of Buerger's disease in Iran

To determine the clinical course of Buerger's disease as observed in two vascular surgery centers located in the capital of Iran. Case series. Sina and Imam Hospitals, Tehran, Iran, during the years 1997 to 2002. The records of all the patients admitted with Buerger's disease diagnosed on the basis of Shionoya's clinical criteria were studied. Their clinical characteristics, treatment offered and short-term follow-up results are described as frequencies and percentages. A total of 116 patients, aged 41.1 +/- 11.3 years, were enrolled. All patients were males; 99% of them were smokers with an average of 22.9 pack-years of tobacco use. Lower-extremity was affected in 102 [87.9%] patients, upper-extremity in 3 [2.6%] patients and both in 11 [9.5%]. The most frequent reasons for being referred to hospital were ischemic ulcers [90.5%], claudication [87.9%], paresthesia [75.9%], rest pain [66.4%], gangrene [60.3%], Raynaud's phenomenon [23.3%] and thrombophlebitis [9.5%]. Diagnostic arteriography, vascular bypass surgery and sympathectomy were performed in 60%, 24% and 83% of the patients, respectively. Sixty-eight patients [58.6%] had one of the following amputations: toe 36 [52.9%], transmetatarsal 3 [4.4%], below knee 25 [36.8%], finger 3 [4.4%] and above knee one [1.5%] patient. Since the studied hospitals are the referral centers for vascular surgery in Iran admitting patients with severe symptoms; therefore, a higher number of complications and amputations was found in the present study. Upper extremity involvement as well as the occurrence of thrombophlebitis and Raynaud's phenomenon was rather infrequent among the studied cases

Outcome of upper gastrointestinal hemorrhage according to the bleed risk classification: a two-year prospective survey

Upper gastrointestinal bleeding [UGIB] is a common and serious medical emergency. The aim of this study was to predict UGIB patients' outcome according to a risk scoring system, independent of endoscopic findings, introduced by Kollef et al [BLEED: ongoing bleeding, elevated prothrombin time, erratic mental status, and unstable co-morbid disease]. Prospective study. Sina university hospital. We studied all patients who presented with UGIB during 2000 to 2002. Patients meeting the BLEED criteria at their initial assessment were classified as high-risk [71] and all others were categorized as low-risk [50]. In-hospital complications were defined as recurrent UGIB, surgery to control the source of hemorrhage and hospital mortality. There were 101 patients, aged 55.7 +/- 20.8 years. Re-bleeding, surgery and death occurred in 21 [20.8%], 28 [27.7%] and 14 [13.9%] of the patients, respectively. Therapeutic and diagnostic upper gastrointestinal endoscopy were performed in 7 [7%] and 83 [82.2%] of patients, respectively. Seventy percent were categorized as high-risk. There was significant difference in development of in-hospital complications, and death when considered individually, between the high and low-risk patients, but not in the rate of re-bleeding, length of hospital stay and transfused units of packed red blood cells. High-risk patients needed surgery more often than the low-risk cases but the difference was borderline significant [p=0.051]. Low systolic blood pressure and elevated prothrombin time were independent predictors of in-hospital complications among BLEED criteria. BLEED classification was capable of predicting in-hospital complications, especially mortality. It is, therefore, a helpful triage tool in centers where urgent endoscopy is hardly available