[Qualitative and quantitative performance of equipment and non-structural vulnerability in selected public hospitals in Tehran city during an earthquake]

One of the important tasks of medical centers is to provide emergency services to the injured during an earthquake. Therefore, these medical centers always should be prepared to deal with such circumstances. Non-structural elements are the important components of medical centers that should be considered. In this study, qualitative and quantitative performance of equipment and non-structural vulnerability of seven public hospitals in Tehran city have been evaluated during an earthquake. In this cross-sectional research, all public hospitals in Tehran city were studied including governmental or public, private, military and also social security. Using WHO/PAHO Standard Checklist, seven public hospitals were selected and evaluated by convenience sampling method in eleven sections. According to the results, the lowest functional level was observed in emergency exit systems, communication systems, furniture and equipment. The studied hospitals were at a satisfactory level in heating and cooling systems, ventilation systems of care units, fire detection and extinguisher. Although 56% of the mentioned hospitals were at a satisfactory level in overall assessment of performance in non-structural features, the critical, vital and effective sections of the hospitals were functioning at an average and some in even low levels of safety. Totally, the hospitals lacked a proper preparation in disaster in non-structural evaluation; furthermore, there was a standard instruction in non-structural immunization that hospitals should consider in preparation

rare late complication of Meckel's diverticulum: diverticulitis induced parietal abscess presenting with multiple abdominal wall fecal fistulae. a case report and review of the literature

This paper presents a case report of 5 years old boy who presented with abdominal pain and fever to the pediatric reception room since four weeks. He was examined and investigated and the possibility of appendiciditis was excluded and a diagnosis of acute non specific mesenteric adenitis was coined. Follow-up medical treatment with antibiotics and conservative measures yielded a parietal abscess in the right iliac region. Simple incision drainage revealed pus and intestinal fecal content. A fecal fistula of appendicular origin was thought for and conservative management continued. However, investigation revealed a communication to the small intestines, and the multi-orifices draining fistulae caused a severe water and electrolyte imbalance with acidosis and emaciation. A decision at exploration revealed a complicated Meckel's diverticulitis, stuck to the abdominal wall and penetrating the muscular wall to end in an arborisation of fistulae in the right iliac fossa and right lumbar region. Resection anastomosis ensured a sound healing of the condition. The peritoneal cavity was exempted from any leak or peritonitis

Management of common bile duct stones in the laparoscopic era: an alternative pathway

The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients

Ultrastructure, transparency and nutrition of the corneal epithelium in the adult rabbit

The present work aimed to study the ultrastructure of the corneal epithelium of the adult rabbit by the electron microscope in an attempt to gain some insight into the structural-functional relationships. Five young adult male rabbits of domesticated New Zeal and white strain were used in this study. The surface epithelium of the rabbit cornea presented fine irregular microvilli and microplicae with a layer of glycoprotein spread over the surface of the corneal epithelium. There are three types of wing cells on the basis of electron density: Light, medium and dark. Between plasma membranes of the wing cells, many desmosomes, gap junctions and zonula adherens were observed. Hemidesmosomes and gap junctions were presented in the basal layer of cells, which established most of the junctional complexes with the basal lamina. The regular architecture of the corneal epithelium allows light to pass with minimal disruption. The squamous epithelial cells have large stores of glycogen that provide an energy reserve. Moreover, the tight junction in the corneal epithelium offers a significant barrier to ion diffusion across the epithelium

Laparoscopic cholecystectomy: modifications of the technique

Laparoscopic cholecystectomy has been rapidly replacing the traditional method of open cholecystectomy. With experience of the technique surgeons are adding and developing technical "tips" and modifying the procedure for better safety and convenience of the patients. This work presented the patients in whom minor modifications of the technique in special situations is made. Three parts only for easy cholecystectomy in 20 patients are used. The second modification is aspiration and retraction of the gallbladder while keeping the Veress needle inside the gallbladder dissection for acute cholecystitis in 10 patients. Modification of umbilical port closure is by the use of Vicryl stay sutures in 10 patients or the use of prolene plug in 10 patients. Laparoscopic cholecystectomy with modifications of the technique was attempted in 54 patients with symptomatic gallbladder disease during the period from January 1992 to January 1994. There was no mortality. The mean operative time was 105 minutes [60-150 minutes]. In 4 patients laparoscopic cholecystectomy was converted to open cholecystectomy. The average hospital stay was 3.6 days [2-8 days] and the mean time taken for return to normal activity was 12 days [7-35 days]

Pilonidal disease of the umbilicus

Six patients [5 males and 1 female] with umbilical pilonidal disease, were treated by excision of the umbilicus with a limited safety margin. Inverting skin-to-aponeurosis sutures were used. A rare case of umbilical pilonidal disease with a urachal remnant is described. The condition is not that rare and requires a high index of suspicion for diagnosis

Ultrasonography in the diagnosis of acute appendicitis

During a 10 month period high resolution sonography was used in the evaluation of 80 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with the surgical and pathological outcome in 53 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appeudicitis with a specificity of 95%, a sensitivity of 86% and accuracy of 91%. The predicitve value of a positive test was 93%, that of negative test was 89%. The results showed that high resoluion sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings

Laparoscopic truncal vagotomy without drainage for the treatment of chronic duodenal ulcer

In this research the short term results of laparoscopic truncal vagotomy without drainage were investigated in 10 patients with chronic duodenal ulceration refractory to long term medical treatment. These patients were 6 males and 4 females. No patients developed symptoms of gastric stasis or ulcer recurrence. There was no mortality, the postoperative complications were minimal, the mean operative time was 140 minutes, the mean hospital stay was 4 days. Endoscopic follow up showed a healed ulcer in 8 patients and inactive ulcer in 2 patients. The technique is described

Mini laparotomy cholecystectomy: modified technique

In this study 150 patients with chronic calcular cholecytits were operated upon as elective mini laparotomy cholecystectomy in a 3-year period. This operation was done through a 5-6 cm incision thus reducing the morbidity of large incisions. The incision was centered upon the funds of the gall bladder helped by the preoperative abdominal ultra sonography. The mean age of the patients in this study was 45 years and the mean weight was 75 kg. The number of female patients was 126, making female to male ratio 6:1. Two types of incisions were done, either transrectal or oblique muscle splitting incision depending upon the location of the fundus of the gall bladder. The mean time of the operation was 60 min and the mean hospital stay was 4 days. The average time to resume normal activity was 10 days and no serious complication occurred in this study. In 14 patients [9.5%] the incision had to be extended for extra 3 cm due to the presence of severe adhesions in the region of Calot traingle mini- lap cholecystectomy performed with the technique by centering the incision upon the fundus of gall bladder using preoperative ultrasound and the use of fiber optic head light attained good exposure in most patients. This procedure was safe and has a definite reduced morbidity than the standard open cholecystectomy

Pre-natal development of the choroid plexus in rabbit

Development of the choroid plexus of the lateral ventricle in rabbit was studied by histological paraffin sections. The choroid plexus is first observed as an invagination from the medial wall of the ventricle at the ninth day of gestation. From the age of 10 days to the age of 13 days prenatally the choroid epithelium is pseudostratified columnar. By the age of 14 days the choroid epithelium starts to present changes from pseudostratified columnar to simple columnar cells. Dark and light can be detected and a large number of metachromatically stained cytoplasmic inclusions at the basal pole can be detected from the age of 16 days prenatally

Pre-natal development of the lens in rabbit

From this study it could be concluded that: 1. The lens placode could be detected on the 6th day of gestation. 2. The lens vesicle was completely formed by the 8th day of gestation. 3. Formation of the lens fibers started in the central cells of the posterior epithelium as their nuclei were thrown forwards to form the primitive lens fibers. 4. The newly formed lens fibers from the equatorial cells were laid down concentrically round the filled - in lens vesicle

Methods for natural and voluntary selection of genders

We are just starting to understand the complexity and the multiple factors influencing the natural choice of genders. This selection has a certain interest in the prevention of diseases or abnomalities which transmission is linked to sexual chromosomes. By combining different methods we can arrive to success rate of 80 to 90%. This stastically significant rate can be improved and we foresee in the near future the possibility for the couples to choose not only the number of their offspring but also their gender

Sensorineural hearing loss in diabetic patients

The effect of diabetes mellitus on the hearing function was studied. Thirty known diabetic patients and 30 control subjects of same age and sex were chosen and investigated by pure tone audiometry, speech discrimination, acoustic reflex threshold and decay. A retrocochlear sensorineural hearing loss was found as a result of the diabetic state with an incidence of 63.3%

Cryosurgery for rhinoscleroma: a new line of treatment

The use of cryosurgery [Double freeze-thaw cycles] in the treatment of rhinoscleroma showed clinical as well as histopathologic cures. The procedure is a safe and simple outpatient procedure causing minimal, if any, discomfort to the patients. It can be repeated safely to extensive lesions for as many times as necessary