Central nervous system and limb embolism concurrence due to atrial myxoma: a case report

Cardiac myxomas are the most common cardiac tumors with diverse nonspecific clinical manifestations. A 78-year-old man presented to the emergency department with complaints of pain and coldness of the left lower extremity. The left femoral artery pulse was detected, while the pulses of the left popliteal, dorsalis pedis, and posterior tibialis arteries were absent. No blood inflow was detected in the superficial and deep femoral, popliteal, and anterior and posterior tibialis arteries. Thrombectomy was performed, and a fatty-like mass from the bifurcation of the common femoral artery and a thrombotic mass from the proximal portion of the superficial and deep femoral arteries were removed. The pulsatile inflow and palpable pulses of the left femoral, popliteal, dorsalis pedis, and posterior tibialis arteries were restored after surgery. The histological findings of the embolus were suggestive of a cardiac myxoma. The patient's consciousness and lower limb blood flow improved gradually. He was discharged from the hospital with full awareness and improved lower extremity muscle function 2 weeks after surgery

An Iranian scoring system for diagnosing Buerger's disease

Buerger's disease or thromboangiitis obliterans [TAO] seems to be common in IR Iran, The present study aimed to evaluate an Iranian population with Buerger's disease in order to suggest a diagnostic criterion for Buerger's disease based on the most frequent findings and to compare it with Papa diagnostic criteria. In a cross-sectional study, all patients with resting limb pain, limb ischemic ulcers, intermittent claudication and limb ischemia who referred to the Vascular Clinic of Sina Hospital during 2009-2011 were evaluated. The patients were allocated to Buerger's and non-Buerger's groups; Evaluating 122 patients [61 in each group], according to the model each clinical manifestations and risk factors in the patients with Buerger's disease obtained a score. Absent pulsation, abnormal distal Doppler sonography and ischemic ulcer were respectively present in 58 [95.1%], 58 [95.1%] and 49 [80.3%] individuals with Buerger's disease. Multivariate linear regression analysis and multivariate logistic regression analysis were used for modeling. Considering the model finding findings, diagnostic criteria including age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus and hyperlipidemia were suggested [R[2]=0.582]; the sensitivity and specificity of the criteria was respectively 95.1% and 78.7%. Compared with Papa criteria, Kappa coefficient was measured at 0.66 with a P-value<0.001. It seems that the recommended criteria have an acceptable accuracy in diagnosing Buerger's disease, especially in the Iranian population; however, it is necessary to conduct more studies with larger sample sizes to evaluate the criteria, especially in other populations

Clinical characteristics and remedies in 45 Iranians with carotid body Tumors

Carotid body tumors [CBTs] are rare, slow-growing tumors that should be considered in evaluating every lateral neck mass. This single center study was performed to define demographic features, clinical characteristics and remedies of Iranian patients with CBT. A retrospective review of prospectively collected data was done on 45 patients with 50 CBTs who have been referred to Sina Hospital, Tehran, Iran, during a 10-year period, were investigated in this study. The demographic characteristics, clinical and pathologic features, imagings, preoperative treatments, surgical approach and complications were analyzed. The study group predominantly consisted of females [82%]. Age of diagnosis was 18 to 75 years old. Five patients had bilateral CBT. Family history of CBT was positive in seven patients. Most of CBTs were

Analysis of 274 patients with extremity injuries caused by the Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The extremity injury pattern after a major earthquake is not well understood because data on this type of injury and management are limited. The aim of this study was to analyze the data of trauma patients with extremity injury in the earthquake of Bam Iran, registering 6.6 on the Richter scale.</p><p><b>METHODS</b>We reviewed medical records of 486 patients admitted to hospitals of Tehran University of Medical Sciences. Among them, 274 patients sustained extremity injuries. This group was composed of 138 females (50.4%) and 136 males (49.6%) and 213 cases (77.7%) were under 40 years of age.</p><p><b>RESULTS</b>Fracture was the major type of injury (58.4% of extremity injuries). The most common sites of injury were lower extremities (185 patients, 67.5% of all victims). Pelvic and rib fractures and abdominal injuries were the most frequently associated injuries. The mean ISS was 6.2+/-4.0, and 61% of the patients had ISS less than 7. Amputation and death occurred in 2.9% and 2.5% of cases, respectively.</p><p><b>CONCLUSIONS</b>Special attention should be given to dealing with orthopedic injuries in similar disasters in the future.</p>

Diagnostic accuracy of CT scan in abdominal blunt trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital.</p><p><b>METHODS</b>All the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients?demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case.</p><p><b>RESULTS</b>CT scan had the highest sensitivity for detecting the injuries to liver (100%) and spleen (86.6%). The specificity of the method for detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively.</p><p><b>CONCLUSION</b>The findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.</p>

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.</p><p><b>METHODS</b>This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant.</p><p><b>RESULTS</b>Two hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%).</p><p><b>CONCLUSIONS</b>Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.</p>

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

Violence against nurses in non-psychiatry emergency wards

Violence against health staff is a widespread problem occurring in different ways and has multiple consequences on health personnel, health systems and even patient care. Emergency Department [ED] personnel especially nursing staff have a higher risk of being exposed to violence, but due to the lack of any recording and reporting system of such incidents, the history of related studies in our country is limited. This exploratory study was conducted in EDs of three major hospitals of Tehran University of medical sciences in 2004, in order to determine the frequency of violence against nursing staff. Data of this cross sectional study were retrieved by questionnaire from 136 nurses working in the ED of three hospitals, Imam-Khomeini, Shariati and Sina. The questionnaire consisted of questions on socio-demographics, previous experience of different types of violence and its reporting. Data were analyzed using statistical software [SPSS] version 11.5. Of study participants, 66.9% were female and 31.6% were male. The overall experience of violence was rather high [98.6%]: 97.8% verbal violence, 39.7% physical violence and 86% other types of violence. Reporting of physical violence was more than the other types. The reasons of underreporting of violence according to the participants were belief in inefficacy of any actions in this regard and their intentions for not magnifying the incident in the workplace. Most of the nurses believed that the possible explanations for the violence incidents they faced were prolonged waiting time in ED, high direct costs, inadequate health insurance, and finally inadequate number of personnel in ED. A majority of nurses had worries about being assaulted in the ER in the future [91.1%]. Exposure to violence especially verbal violence among nurses working in EDs is high, but despite the high prevalence of worrying about reoccurrence of violence, most of the cases remain unreported and don't result in a legal action. It seems that arrangement of systematic educational courses concerning prevention of violence and conflict resolution for ER staff, empowerment of security systems like guards, adoption of strategies to support assaulted staff and take effective legislative actions against aggression and violence in the health systems may be effective to reduce the burden problem

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

Epidemiology of urogenital trauma in Iran results of the Iranin national trauma project

We report the incidence, distribution, etiology, and outcome of the urogenital trauma in 8 major cities of Iran according to the database of national trauma project. Between 2000 and 2004, we prospectively collected the data of all the traumatic patients hospitalized for more than 24 hours in 8 cities [Tehran, Mashad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol]. We analysed the data taken from 17 753 trauma admissions. Patients with sustained urogenital traumas were identified and studied. A total of 175 patients [0.98%] had injuries to the urogenital system. Male to female ratio was 4. The patients' mean age was 25 +/- 16 years [range, 2 to 80 years]. Of 175 patients, 159 [90.9%] had blunt trauma and 16 [9.1%] had penetrating trauma. Road traffic accident was the most common cause of trauma [65.1%]. The most common injured organs were the kidney in 61.1% and the bladder in 13.7%. One hundred and forty-two patients [81.1%] had associated intra-abdominal injuries and 129 [73.7%] had other accompanying injuries. Sixty [34.2%] patients required surgical intervention. Nine patients [5.2%] died due to the severity of the injuries. All patients who died had severe injuries [Injury Severity Score >12]. In Iran, blunt traumas including road traffic accidents are the main cause of urogenital traumas. The majority of the patients with urogenital trauma have multiple injuries and require a multidisciplinary approach