Spinal Tuberculosis: Diagnosis and Management

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.

Patterns of extremity traumas leading to amputation in Iran: results of Iranian National Trauma Project / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the patterns of traumatic extremity injuries leading to amputation in Iran.</p><p><b>METHODS</b>Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004.</p><p><b>RESULTS</b>Of 17 753 traumatic patients, 164 (0.92%) had injuries to the extremities that resulted in the limb amputation. Of these, 143 (87.2%) were men. The patient's mean age was 29.0 years +/- 15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%). One hundred and four cases were occupational accidents (63.4%). Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%). Amputation of hand fingers was the most frequent type of amputation (125 cases, 76.2 %). One patient died from severe associated injuries.</p><p><b>CONCLUSIONS</b>This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.</p>

Comparison of road traffic fatalities and injuries in Iran with other countries / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To compare fatalities and injuries in road traffic crashes (RTC) in Iran with other countries.</p><p><b>METHODS</b>Data were obtained from national health sources of Iran. These data included population number, registered motor-vehicles number, number of RTCs and consequent fatalities and injuries from 1997 to 2006.</p><p><b>RESULTS</b>RTC fatality and injury rates increased from 1997 to 2005, but decreased in 2006. The overall men/women ratio in the RTC fatalities was 4.2:1. High RTC fatality rate of 39 per 100 000 population in Iran was almost the same as some other developing countries. In Iran, RTC fatalities in recent years were almost twice as much as the highest rate among the European countries.</p><p><b>CONCLUSIONS</b>This investigation shows that in spite of reduction of RTC fatality in Iran in 2006, it is still one of the highest in the world. Moreover, this paper describes the state of RTC-related parameters in a developing country in comparison with the developed countries.</p>

Spinal cord injuries from road traffic crashes in southeastern Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the data of patients with spinal cord injury (SCI) induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning.</p><p><b>METHODS</b>In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated.</p><p><b>RESULTS</b>Among 64 patients with SCI, 38 patients (59.4%, 36 males and 2 females, aged 27.42 years+/-9.44 years on average) were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases (68.4%) and 12 cases (31.6%), respectively. And 31 patients (81.6%) had complete SCI. Conus medularis (T12-L2) was the most affected level.</p><p><b>CONCLUSIONS</b>Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.</p>

Creation of permanent hemodialysis vascular access in patients with failed arteriovenous fistula

To compare the patency rate and complications of arteriovenous fistula [AVF] with synthetic graft in patients with previous history of failed AVF. This study was carried out at Sina Hospital, Tehran, Iran from April 2002 to July 2003. Patients who had been referred to our center with previous failed attempt for creation of AVF were collected. We again tried to create an AVF in some of these patients according to physical examination and clinical judgment of the vascular surgeon. A synthetic graft was inserted for the remainder of the patients. All patients were followed up for 3 months. Elbow fistula placement was possible in 43% of patients including half of patients with diabetes and half of those more than 65 years old. Failure occurred in 33% of grafts versus 19% of fistulas. The complications were venous hypertension in one case and infection in 2 cases, all from the graft group. Our results show lower failure, mortality, and complication in AVFs than the synthetic graft, similar to previous reports. However, there were some limitations such as small sample of patients and short duration of follow up in our study. We suggest that AVF is an option even in patients who had previous multiple procedures with the advantage of being cost-effective, and with fewer complications. However, we cannot conclude any superiority for one method, as it is not a properly designed comparative trial