A simple technique for morphological measurement of cerebral arterial circle variations using public domain software (Osiris) / 대한해부학회지

This article describes a straightforward method to measure the dimensions and identify morphological variations in the cerebral arterial circle using the general-purpose software program Osiris. This user-friendly and portable program displays, manipulates, and analyzes medical digital images, and it has the capability to determine morphometric properties of selected blood vessels (or other anatomical structures) in humans and animals. To ascertain morphometric variations in the cerebral arterial circle, 132 brains of recently deceased fetuses, infants, and adults were dissected. The dissection procedure was first digitized, and then the dimensions were measured with Osiris software. Measurements of each vessel's length and external diameters were used to identify and classify morphological variations in the cerebral arterial circle. The most commonly observed anatomical variations were uni- and bilateral hypoplasia of the posterior communicating artery. This study demonstrates that public domain software can be used to measure and classify cerebral arterial circle vessels. This method could be extended to examine other anatomical regions or to study other animals. Additionally, knowledge of variations within the circle could be applied clinically to enhance diagnostic and treatment specificity.

use of head CT scanning in mild head injury

To determine the number of brain CT scans carried out in patients with mild head injury [MHI] during 13 months of trauma registry, and to investigate means of reducing the rate of unnecessary scans. During a trauma registry [from August 23, 1999 to September 21, 2000] in 6 general Hospitals [Imam Hussein, Moayer, Sina, Hafteteer, Imam Khomeini and Shariatti] in Tehran, Iran, 1209 cases with Glasgow Coma Scale [GCS] score >13 underwent brain CT scan. To be included in the study, patients must have sustained their injury within one week prior to presentation to Emergency Rooms, and were hospitalized for more than 24 hours. The attending physicians formally reported all brain CT scan findings. For 1209 patients, there were the following characteristics: mean age was 29.4 years; the main cause of injury was traffic accidents [60.1%], followed by falls [28.5%], fights [7.2%], and other reasons [4.2%]. Seventy-seven cases [6.4%] had a GCS score of 13, 212 [17.5%] had a score of 14, and 920 [76%] had a score of 15. A total of 481 abnormalities on CT scan were reported for 405 patients [33.5%] with positive report of brain CT scan, while 804 cases [66.5%] did not report abnormalities. The most common intracranial lesion was epidural hemorrhage with 146 cases [30.3%]. The rate of negative reporting of brain CT scan in patients who had GCS score of 15 was 72.2%. Patients who have GCS score of 13 or 14 on admission should be considered to have a moderate rather than a mild head injury. For reduction of unnecessary brain CT scan performance in MHI patients, we must define the appropriate criteria

evaluation of the possible effect of positive end expiratory pressure [PEEP] on pharmacokinetics of phenytoin in patients with acute brain injury under mechanical ventilation

Positive ventilation has shown to have an influence on pharmacokinetic and disposition of some drugs.Beacause phenytoin with a narrow therapautic range, is the most commonly used drug for prophylaxis and treatment of early seizures after acute brain injuries, in the present study the effect of short term PEEP [5-10 cm H2O for at least 8 hours] on phenytoin serum concentration and pharmacokinetic parameters such as Vmax and clearance in brain injured patients under mechanical ventilation was examined. Ten patients with moderate to severe acute brain injury who were placed on mechanical ventilation with an initial PEEP level of 0-5 cm H2O were included in the study. Patients received phenytoin loading dose of 15 mg/kg followed by a maintenance daily dose of 3-7 mg/kg initiated within 12 hours of loading dose. Sampels were taken on two different occasions before and after PEEP elevation. Total phenytoin serum concentrations were determined by HPLC method. A time invarient Michaelis-Menten pharmacokinetic model was used to calculate Vmax and clearance for each patient.Derrived variables were calculated as follows: Vmax, 3.5-6.8 and 3.7-8.2 mg/kg/day; Clearance, 0.1-0.7 and 0.1-1.2 l/kg/day [before and after PEEP elevation, respectively]. Our data have shown a wide range of variability [2.6-32.5 mg/l] in phenytoin serum concentrations. There were no statistically significant differences in the measured total concentrations [p=0.721] and calculated Vmax and clearance [p=0.285]before and after PEEP elevation. Administration of fluid and inotropic agents, limitation in application of higher levels of PEEP and drug interactions, shall be considered as possible explanations for these findings

Pattern of cigarette smoking in an Iranian village

Background: Financial burden due to tobacco use is known all over the world. A high percentage of preventable cancers, respiratory and non respiratory diseases are due to cigarette smoking. Mortality rate due to cigarette smoking is approximately 4 million deaths per year at the present time; this figure is going to reach 10 million deaths per year by the year 2020 if the present trend continues. What makes countries and different districts different from each other in regard to the severity of the risks of cigarette smoking is the prevalence of cigarette smoking, mean age of starting smoking, and mean number of cigarettes smoked daily in that area

Materials and Methods: A weighted representative sample of 310 inhabitants of North rural area [Babol city] was selected randomly in the year 2002. The data were collected by face to face interview and daily smoking prevalence was 28.2% [The standardized rate directly according to the sex is about 17.15%]

Results: The mean age of starting smoking in smokers was 21.4%. More than 80% of persons stated that they had started smoking before the age of 25 years. The mean number of cigarettes smoked daily was 16.8 cigarettes per day

Conclusion: Female gender [p <0.000], having higher level of education [p=0.023], and increased age [p=0.041] were recognized as the distracting factors from cigarette smoking