[Effects of bupivacain infiltration on insulin, glucose, prolactin and cortisol responses to operative stress after unilateral inguinal hernoiraphy among 3-7 year-old children]

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluated its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years [24 females, 92 males] undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages [preincisional stage, at the end of operation and 4 hours after operation] to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4[th] hour of postoperative period in experimental group, there were no statistically significant difference compared to those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects

sensitvity, specificity, positive and negative predictive values of stool color test, triangular cord sign and hepatobiliary scintigraphy in diagnosis of infantile biliary atresia

It is very important to detect biliary atresia in a timely manner to prevent progressive damage to the liver. Our attempt was to formulate our diagnostic approach to infantile cholestasis in Mofid Children's Hospital in Iran. Forty two records of infants with prolonged conjugated cholestatic jaundice from 2003 to 2008 were reviewed with regard to the infants' gestational age, birth-weight, stool color, liver function test results [total bilirubin, direct bilirubin, ALT, AST, alkaline phosphatase, albumin, globulin, and cholesterol], ultrasonography, hepatobiliary scintigraphy findings, liver biopsy results and ultimately intra-operative cholangiographies [IOC]. Total bilirubin, direct bilirubin, AST, AST to ALT ratio, cholesterol, and globulin were significantly higher in infants with biliary atresia [BA] as compared to those in the other group. We found that gestational age and birth weight were significantly lower in infants without BA. Stool color sensitivity, specificity, positive predictive value, and negative predictive value in diagnosis of BA were 100%, 83%, 81%, and 100%, respectively. These figures for triangular cord [TC] sign were 72%, 91%, 86%, 81%, respectively and for hepatobiliary scintigraphy were 100%, 85%, 100%, and 85%, respectively. In biliary atresia, history, physical exam, and liver function tests can be the first steps in diagnostic algorithms followed by colored stool. However, if TC is not visualized, hepatobiliary scintigraphy is suggested. If excretion of tracer does not occur, liver biopsy is indicated. The definite diagnosis would be possible by an intraoperative cholangiography

Injury epidemiology in Kermanshah: the National Trauma Project in Islamic Republic of Iran

In a cross-sectional study, all trauma patients hospitalized for 24 hours or more over a 4-month period in Taleghani hospital, the only referral teaching centre in Kermanshah city, were studied [n = 779]. Mean age was 34.7 [standard deviation 19.9] years. Male, unemployed and illiterate patients predominated. Road traffic accidents, falls and interpersonal violence were the most common mechanisms of injury. Among road traffic accident victims, pedestrians were the most vulnerable group. A total of 7.8% of patients died, mostly due to head injuries [78.7%]. Our findings also showed the importance of head trauma as the main anatomical site of injury