ABSTRACT
Introduction: Construction of vascular access using subcutaneously placed to join an artery to a vien is increasly necessary in patients with poor peripheral veins or previously failed arteriovenous fistulas. Interposition grafts in the lower extremity are used for patients who have no usable vessels available in the upper arms. Experience with groin hemodialysis prosthetic access has been discouraging because of high infection rate and associated limb amputation
Objective: Determine infection rate, patancy rates, and possible prediative factors for prosthetic thigh angioaccess outcomes in our hemodialysis patient's population
Materials and Methods: In this prospective study 41 patients who were underwent placement of thigh vascular access graft at Sina Hospital ,Tehran University of Medical Sciences, were selected between Jan 2000 and July 2003. Data were recorded base on demographic and complications variables and analyzed by Kaplan-Meier and long rank tests
Results: In this study the primary of thigh prosthetic graft were, 76%, 70%, 67%, and 60% at 3, 6, 9, and 12 months after placement respectively. There were 14 [34%] access failures, related to infection in 2 case [4.8%], thrombosis in 10 cases [24.4%] and psuedoaneurysms in two cases [4.8%]. There was no limb ischemia, no significant difference in infection or graft patancy rate which were found by patient age and gender
Conclusion: In this study, infection and thrombosis rate of thigh access was not more than other studies. Thigh vascular access with PTFE could be used for patients who have no usable vessels available in the upper arms
ABSTRACT
Introduction: Acute appendicitis is one of the most common problems requiring emergency surgery. Diagnosis is based on history, physical examination and laboratory findings. Rate of misdiagnosis of appendicitis especially in female is up to 23.2%. Some basic laboratory examinations such us white blood cell count, CRP and ESR have been suggested as aids in the diagnosis of acute appendicitis. But results are controversial
Objective: This study was designed to consideration of association rate of leukocytosis, increased CRP and ESR in acute appendicitis
Materials and Methods: In this prospective study, 158 patients were admitted with clinical diagnosis of acute appendicitis from September 2001 to March 2002 in Poursina hospital in Rasht. Blood samples for WBC, CPR and ESR were sent to the laboratory preoperatively. Then sensitivity, specificity, PPV and NPV of these tests were determined and analyzed
Results: There were 98 males [62%] and 60 females [38%]. The mean age was 28.41 years [range 3 to 70 years]. 146[92.4%] patients have histologically confirmed appendicitis and 12[7.6%] had normal appendix. Sensitivity, specificity, PPV and NPV for leukocytosis were in order: 84.2%, 33.3%, 93.9% and 14.8% for increased CRP were in order 79.4%, 25%, 92.8% and 9.09%, and for increased ESR were: 69.2%, 8.3%, 90.2%, 22% in orderly. When all tests are used for diagnosis, these criteria were 54.8%, 66.6%, 95.2% and 10.8% respectively. In attention to sensitivity and value of positive [PPV] and increased WBC, CRP and ESR, it can be resulted that positivity of these tests in suspected appendicitis can strengthen the clinical diagnosis but lowered value of negative [NPV] tests showed that the negativity of each test or all tests together can not verify acute appendicitis
Conclusion: In presence of Leukocytosis, increased CPR and ESR probability of appendicitis was increased in clinically acute appendicitis. But normal value of WBC, CRP and ESR don't rule out acute appendicitis
ABSTRACT
Introduction: In different countries, different etiologic factors are considered to be responsible for acute pancreatitis
Objective: In this study we tried to determine the relative frequency of etiologic factors of acute pancreatitis in our patients
Materials and Methods: This study is a retrospective one and we studied all patients with documented acute Pancreatitis in Poursina and Razi Hospital. 185 patients were studied from1994-1999. Data were processed
Results: From 185 pt, 97[61%] were female and 61 were male [39%]. The ratio of female to male was 1.59. Most patients were 41-50 years old. For 78pts [49%], the etiologic cause was unknown, [Idiopathic].Known causes included: Biliary stone [41%], Alcohol [3.3%], previous surgery [1.9%, and trauma [0.63%]. Mortality rate was 13.3% [21pts] with highest rate in 61-70 year old age group. Diagnoses of 17 cases were revealed after explorative laparatomy
Conclusion: In this study in 49% of Pancreatitis, the etiologic causes weren't known; in other studies 7-21% of Pancreatitis was idiopathic. It may be due to missing of other causes; the biliary stones were the most were the most cause of acute pancreatitis. This is different from other studies in American and European countries