Helicopter emergency medical service in Fars province: the referral trauma center of South of Iran

Considering the limited available resources, high cost of the helicopter emergency medical service [HEMS], and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respec-tively while 46.3% of patients were in the proper group, and the rest were considered as improper group. Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases

Squamous cell carcinoma of the esophagus and adenocarcinoma of gastroesophageal junction, a rare coincidence

Simultaneous squamous cell carcinoma [SCC] of esophagus and gastroesophageal adenocarcinoma has rarely been reported. It is often difficult to diagnose this coexistence preoperatively due to the presence of esophageal stenosis. Herein, we report a patient with esophageal SCC whose gastroesophageal adenocarcinoma was also detected after pathologic examination of the resected specimen

Cardiopulmonary arrest outcome in Nemazee hospital, southern Iran

Many factors are important determinants in the outcome of cardiopulmonary resuscitation [CPR] such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran. From October 2007 to March 2008, all patients who received in-hospital CPR in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. Two standard scales of ROSC [Return of Spontaneous Circulation] and DR [Discharge Rate] were used to evaluate the efficacy of CPR. Two hundred and seventy one patients [45.1%] had ROSC while 329 [54.9%] died immediately after resuscitation. Among ROSC patients, 18 [6.6%] cases were discharged from the hospital [3% of study population]. Although ROSC was comparable with developed countries, but the DR was lower. It shows that in our area, post-resuscitation care needs more attention in relation to organized trainings and the skills in post-resuscitation care together with expansion of the facilities

clinicolaboratory scoring system for the management of acute appendicitis

Despite widespread imaging techniques which have significantly improved the management of acute appendicitis, cost-effective clinical decision-making concerning this condition is still a matter of debate. The aim of this study was to design a simple scoring system based on routine clinical and paraclinical data in patients suspected of having acute appendicitis. In this cross-sectional study, 402 consecutive patients, clinically suspected of having acute appendicitis and who were referred for general surgery consultation were evaluated. Nine common clinical and laboratory data including abdominal guarding, fever, shifting pain, leukocytosis, rebound tenderness, tenderness on rectal examination, vomiting, right lower quadrant tenderness and anorexia/nausea were recorded in each case and individually evaluated for sensitivity, specificity, positive predicted value and accuracy based on final outcome. A score of 3 was attributed to sign/symptoms with an accuracy of >/= 80%, 2 to sign/symptoms with an accuracy of 60-70%, and 1 to sign/symptoms with an accuracy of 50-70%. By selecting a cut-off point of more than 7 for operation and 6-7 for observation, the proposed scoring system decreased the negative appendectomy rate to 6.6% and observation rate to 3.5% as compared to 29% and 18% respectively, in conventional decision making. Applying this scoring system can improve clinical decision-making in acute appendicitis and effectively reduce negative appendectomy rates without increasing the rate of complications