Efficacy of core decompression of femoral head to treat Avascular Necrosis in intravenous drug users

Core decompression [CD] of the femoral head is one of the effective treatments of avascular necrosis [AVN], especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients [with the total number of 37 femoral head] who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% [n=17] were female, 32% [n=8] were male, and the average of the age of the patients were 29.58 +/- 4.58. Eight of these patients had systemic lupus erythematous [SLE] [32%], 4 rheumatoid arthritis [RA] [16%], 3 with kidney transplant [12%], 1 Takayasu's vasculitis [4%] and 1 Wegner vasculitis [4%]. Eight of patients had a history of intravenous injection of Temgesic [32%]. In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment [P=0.03] in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head

[Surgical tracheostomy versus percutaneous tracheostomy in the intensive care unit]

Prolonged intubation and need to mechanical ventilation is an indication for tracheostomy. This procedure can be done, surgical or percutaneous. In this study, we compare surgical and percutaneous dilated tracheostomy. In this retrospective study, which was conducted in ICU wards of Rasool Akram Hospital from Mehr 1387 to Mehr 1390. We compared complication of tracheostomized patients in two groups. In this study, early postoperative bleeding, in 11 cases, 1 case [4.2%] in PDT group and 10 cases [17.5%] in surgical group was shown [with a significant difference]. Surgical site infection in 1 case, 2 cases [7.4%] in PDT group and 1 case [4.2%] in surgical group was shown [with a non-significant difference]. Subcutaneous emphysema in 11 cases, 2 case [8.3%] in PDT group and 1 case [1.7%] in surgical group with a significant difference, was shown. Other complications such as tracheal posterior wall were not shown in both groups. Because of lower complications rate and bedside PDT doing, percutaneous tracheostomy is a safe and suitable alternative for surgical tracheostomy

[ effect of administering warmed intravenous fluids on maternal body core temperature in cesarean delivery]

Hypothermia is a common complication in surgeries patients and may have serious consequences in both mother and fetal in cesarean surgery. This study was implemented to assess the effect of intravenous [IV] infusion of warm fluids on decreasing hypothermia in mothers and its consequences on newborns. This randomized controlled clinical trial was done on 70 candidates of elective caesarean surgery. First group received IV infusion of 38[degree] C fluids, second group got IV infusion of room temperature fluids. Mother`s core temperature, during the surgery and after the surgery, systolic blood pressure, pulse rate, postoperative shivering and APGAR of newborns were assessed. The administration of warmed fluids prevented shivering [p < 0.01] and hypothermia 30 minutes postoperatively and 1 hour after in the recovery [p<0.01]. There were no significant differences in other variables. Infusion of warmed IV fluids can decrease hypothermia and its complications namely shivering in cesarean section

Remifentanil versus fentanyl for assisted reproductive technologies: effect on hemodynamic recovery from anesthesia and outcome of ART cycles

We conducted this study to compare the outcome of assisted reproductive technology [ART] procedures and recovery from anesthesia in women who received opioid analgesia with remifentanil versus fentanyl. This double-blind, randomized clinical trial was carried out in the Yazd Research and Clinical Center for Infertility, Yazd, Iran. We studied 145 women who were participants in an ART program. During the first phase of the study, all patients underwent induction of anesthesia with thiopental and received analgesia with remifentanil or fentanyl. The primary endpoint was pregnancy rate per transfer. The numbers of oocytes collected, fertilized and cleaved were recorded, as was the number of oocytes transferred and recovery profile. In the second phase of the study, all patients were followed for outcome of ART cycle. This study suggested that in women undergoing transvaginal ultrasound-guided oocyte retrieval procedures, the likelihood of a successful pregnancy was higher with a remifentanilbased monitored anesthesia care [MAC] technique than with a fentanyl-based MAC technique. The recovery from anesthesia was significantly better in the remifentanil group versus fentanyl group. The results of this study suggest that remifentanil in clinical practice is superior to fentanyl [Registeration Number: IRCT201009283468N3]