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>

Thoracic injury: a review of 276 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all trauma-related deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.</p><p><b>METHODS</b>A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury, injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.</p><p><b>RESULTS</b>There were 246 males (89.1%) and 30 females (10.9%) ranging from 3 to 80 years with a mean age of (34+/-17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1%) and falling injuries (32 cases, 11.6%), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2%) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.</p><p><b>CONCLUSIONS</b>According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.</p>

Chest injury in victims of Bam earthquake / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS) for better understanding the type and consequence of thoracic injuries in a major earthquake.</p><p><b>METHODS</b>After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.</p><p><b>RESULTS</b>This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multiple-trauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P=0.003).</p><p><b>CONCLUSIONS</b>Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.</p>

Synchronous surgical removal of suspicious ovarian metastases from colorectal cancer

Metastatic ovarian cancers occur in 3-8 percent of women undergoing surgical resection of a primary colorectal cancer. In this study we examined the characteristics of women with colorectal cancer for whom synchronous oophorectomy had been performed.In this cross-sectional study, records of patients with colorectal cancer from April 1991 through October 1999 who had undergone surgery for both colorectal cancer resection and oophorectomy for suspicious ovarian metastasis in the Cancer Institute, Imam Khomeini Medical Center, were reviewed. SPSS version 10 was used for statistical analysis.The studied cases [n= 82] comprised 44.1 percent of all recorded cases of women with colorectal cancer during this period [N= 186]. The mean age of our cases was 52.19 years. 54.9% of the studied women were in stage C of colorectal cancer. The commonest pathology of tumors was adenocarcinoma [89%]. Well differentiated carcinoma was observed in 43.9%, followed by moderately differentiated carcinoma in 37.8%, poorly differentiated in 12.2% and unspecified in 6.1%. 22 of our patients [26.8%] had gross abnormalities of ovaries at operation. In 13 cases [15.8% of our 82 studied cases and 6.99% of all 186 women with colorectal cancer], tumoral involvement of ovaries was proven through pathologic examination. 10 out of these 13 cases were among those with gross abnormalities of ovaries at operation [p= 0.048]. Among the 13 patients with ovarian metastasis, 11 cases [84.6%] were in stage C at operation [p= 0.02] and 7 [53.8%] had well differentiated carcinoma [p= 0.04].Patients with ovarian metastases of colorectal origin are generally peri- or post-menopausal. Like similar studies, in our setting, about 7 percent of all recorded female cases with colorectal cancer turned out to have ovarian metastases in surgical pathologic examination in fact, 15.8% of our 82 cases sustaining surgery for [[colorectal cancer and suspicious ovarian metastases]] proved to have ovarian metastases. We recommend that prophylactic oophorectomy be performed in postmenopausal women with advanced stage colorectal cancer or any other women with colorectal cancer with gross abnormality of the ovarian at operation