study on the survival of allograft in patients with major burn injuries at Imam Reza Burn Center

In the treatment of patients with severe burns, it is a matter of urgency to achieve definitive and total wound closure in order to avoid the metabolic abnormalities and septic complications of an open wound. In the absence of autologous skin, allograft skin is the best alternative for wound coverage. The purpose of this study was to evaluate survival of allograft in major burn injuries. This cross- sectional descriptive study, carried out from 2004 to 2006 on seventeen female patients with severe burns, ranged from 60% to 90% total body surface area in Imam Reza Burn Center. Allograft was used for wound coverage from first degree relatives, and patients were followed up for six months. Data were recorded in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Twenty two allografts were used in the course of treatment of 17 severely burned patients. Five patients [29%] had two allografts and 12 patients [71%] had one allograft. In 9 patients [53%] rejection of transplanted skin was observed. In 3 cases [18%], rejection in one of the allografts was observed, while in 5 patients [29%] the total transplanted skin was rejected. Allograft is an effective alternative treatment to resurface major burns in case of limited auto skin graft donor site, and the percent age of rejection was much lower than the other studies

[ comparison between results of topical nitroglycerin ointment and sphincterotomy in chronic idiopathic anal fissure]

Chronic anal fissure is a common problem, and there are different ways for treatment. The goal of this study was to compare the effectiveness and complications of topical nitroglycerin with internal sphicterotomy in the treatment of chronic anal fissure. This randomized clinical trial study was performed from 2002 to 2005 at Imam Reza Hospital, Mashhad, Iran on 200 patients with symptomatic anal fissure, who randomly categorized into two groups of case [n=100] and control [n=100]. The case group [A] treated with nitroglycerin ointment%0.2 twice a day for 6 weeks and the control group [B] recieved sphincterotomy. Individual, surgical and medical results data were recorded in the questionnaire. Data analyzed using descriptive statistics, frequency distribution tables, and Fisher test. after 6 weeks of treatment, results showed that healing was not significantly different between the two groups, but after 6 months, difference was significant [p=0/11]. Surgical group healed 100%. Headache in medical group was more noticable than the other group [p<0/001]. But hypotension attack, palpitation, dizziness, and vomiting were not considerably different between the two groups. Internal sphincterotomy is superior to topical nitroglycerin in treatment of chronic anal fissure, with a high rate of healing, few side effects, and low risk of early incontinence

[Treatment of penetrating lung parenchyma injuries]

Reports of military injuries have advocated early thoracotomy and aggressive management of pulmonary injuries with resection; which opposed to the more conservative and traditional treatment with chest tube thoracostomy in civilian trauma. This study is done in order to study the result of urban lung injury treatment. A retrospective descriptive study was performed in the General Surgery Department of Imam Reza Hospital during the years 1382 - 1383, to determine the incidence of thoracotomy and lung resection in civilian injuries and to evaluate the effective treatment of these injuries in 1168 patients. Indications of thoracotomy were: 1- Air leakage after 2 weeks, 2- drainage of more than 1500 cc blood after tube thoracostomy, 3- Bleeding speed more than 200cc/hour, 4-Massive air leakage with collapsed lung. All patients with mediastinal or heart trauma were excluded from this study. Personal, laboratory and treatment data were recorded in the quastionare. Data was Analyzed using qualitive statistics and frequency distribution tabels. Between 1368-1382 in a series of 1168 patients, there were 384-gunshot wound and 784-stab wound to the thorax. 283 patients with gunshot wound [74%] and 602 with stab wound [77%] were treated with chest tubes alone. 68 patients [9%] of the total required operative thoracotomy. Pulmonary resection was done in 18 patients [9 wedge resection, 6 lobectomy and 3 pneumonectomy]. Mortality rate for all injuries was 2/3%, 0.7% for those treated with chest tube alone, 30% for pulmonaryhilar injuries which led to pneumonectomy, 8.6% for sewed parenchymal injuries and 28% for lung resection. Most civilian lung injuries can be treated by tube thoracostomy alone. Only 15-30% will require thoracotomy, among those most injuries can be handled by simple over - sewing of the lung. Some patients may require pulmonary resection because of sever tissue destruction, in these injuries lobectomy may be performed