[Postoperative mortality and morbidity of carotid endarterectomy in patients with carotid stenosis]

Carotid stenosis is the most common cause of cerebrovascular accidents. If we select the patients appropriately, carotid endarterectomy would be acceptable regarding to mortality and morbidity for vascular complications. Since, carotid endarterectomy related complication is dependent on experience, equipment and facilities of surgical team, each surgical ward should be evaluated for complication separetely. Evaluating the postoperative mortality and morbidity and complication of carotid endarterectomy in patients with carotid stenosis in surgical wards of Razi Hospital in Rasht during September 2006 until end of February 2010. In this descriptive study, 51 patients undergoing carotid endarterectomy in surgical wards of Razi Hospital were recruited. Postoprative complications, mortality and morbidity of carotid endarterectomy were recorded during hospitalization and one month follow up period after discharge. The mean age of patients was 66.69 +/- 10.33. 35 subjects of patients were male and 16 subjects of patients were female. Mortality was reported in one case [%1.96], complication in asymptomatic patient was [%1.96], in symptomatic patient with Transient Ischemic Attack was [1.96%] and in Cerebro Vascular Accident patients was [0%]. Results of this study showed that the rate of mortality and morbidity is acceptable after endarterectomy surgery in Razi hospital in comparison with NASCET. So in order to elevation of quality of surgery in this center, results of surgery should be recorded and analysed every year

[Comparison the number of triaged patients in three working shift in Poursina hospital in Rasht]

Abstract Introduction: Triage defined as selecting patients based on the severity of injury and performing the best management for the majority of patients in a short time. Triage is a strong administrative tool for providing emergency services. According to situations, it divided into: normal urgent triage and emergent condition triage. The former is performed in emergency ward of a hospital and the latter in the accident field

Objective: Comparison of the number of triaged patients in normal urgent condition at different triage levels in accordance with months of the spring and three working shifts

Materials and Methods: This cross-sectional retrospective study was performed in Poursina teaching hospital during three months of the spring [21 March-21 June 2006]. Patients triaged in three working shifts. Data were registered in Emergency Service Work Shifts Form [approved by Ministry of Health, Treatment, and Medical Education]. According to this form, patients were classified to inpatients and outpatients groups, then they allocated to one of the following levels: Emergent, Urgent, and Non-urgent

Results: Among 30.746 admitted patients, 25.525 [82.97%] were outpatients, 5.214 [16.95%] were inpatients, and 25 [0.08%] died. 203 [3.89%] patients transported by EMS ambulances, 960 [18.41%] by referee hospital ambulances, and 4.051 [77.70%] by themselves or others. The mean number of inpatients on night shift had a statistically significant difference of morning and evening shifts. The same was true for outpatients between morning and evening and night shifts. The majority of inpatients, 2.104 [40.30%] admitted on the night shift and the majority of outpatients, 12.443 [48.21%] on the morning shift. There was a statistically significant difference between the mean of triaged patients at the emergent and urgent levels among the three work shifts [night vs. morning and evening shifts, p< 0.05]

Conclusion: Regarding the majority of admissions on the night shift, pay more attention to this shift can play a pivotal role in saving lives. Therefore, it appears that conducting more studies about the different aspects of this issue is necessary

[Survey the patency rate and complications of groin A-V graft access]

Introduction: Construction of vascular access using subcutaneously placed to join an artery to a vien is increasly necessary in patients with poor peripheral veins or previously failed arteriovenous fistulas. Interposition grafts in the lower extremity are used for patients who have no usable vessels available in the upper arms. Experience with groin hemodialysis prosthetic access has been discouraging because of high infection rate and associated limb amputation

Objective: Determine infection rate, patancy rates, and possible prediative factors for prosthetic thigh angioaccess outcomes in our hemodialysis patient's population

Materials and Methods: In this prospective study 41 patients who were underwent placement of thigh vascular access graft at Sina Hospital ,Tehran University of Medical Sciences, were selected between Jan 2000 and July 2003. Data were recorded base on demographic and complications variables and analyzed by Kaplan-Meier and long rank tests

Results: In this study the primary of thigh prosthetic graft were, 76%, 70%, 67%, and 60% at 3, 6, 9, and 12 months after placement respectively. There were 14 [34%] access failures, related to infection in 2 case [4.8%], thrombosis in 10 cases [24.4%] and psuedoaneurysms in two cases [4.8%]. There was no limb ischemia, no significant difference in infection or graft patancy rate which were found by patient age and gender

Conclusion: In this study, infection and thrombosis rate of thigh access was not more than other studies. Thigh vascular access with PTFE could be used for patients who have no usable vessels available in the upper arms

[Evaluation of transhiatal esophagectomy for esophageal cancer]

Introduction: Esophageal cancer is an invasive tumor with a poor prognosis. Unfortunately, this malignant tumor has a considerable prevalence in north part of Iran, especially near the Caspian Sea. It is also an important cause of cancer-related mortality. Surgery is the most effective approach for cure and also is used for palliation. Transmittal esophagectomy is a popular method of resection with a low morbidity and mortality

Objective: We designed this study to document the clinic pathologic characteristics of patients undergoing this procedure for esophageal cancer and to determine the contributing factors survival of patients

Materials and Methods: This descriptive study was performed between 1993 and first half of 2003 on 162 patients in Rasht Razi hospital. Patients' medical records were surveyed regarding their age, sex, stage of dysphagia, complications of surgery, mortality, stage of cancer and level of survival. Data were analyzed by EPI-6 software

Results: There were 102 male and 60 female patients. The mean age of patients was 57 years. 29.1% of them were urban versus 70.9% who were rural. The most frequent presenting symptoms were dysphagia [100%]. The most common site of tumor was lower third of esophagus [56%] and cardia] 22%]. 47.1% of patients required tube thoracostomy after surgery.9.8% of patients were splenectomized because of splenic injury. Recurrent nerve damage was observed in 4% of patients. 18.4% of patient's required mechanical ventilation. Pneumonia, Mediastinitis and Chylothorax was observed in 10, 2 and 2% of patients respectively. 13% had anastomosis leak in neck, which was managed conservatively. 83.1% of patients, were discharged from hospital in two weeks. The mean duration of hospital stay was 9.94 +/- 4.14 days. 14% of patients expired during first month of hospitalization. Survival in 1,2,3,4 and 5 years were 80%, 50%, 40%, 30% and 20% respectively

Conclusion: In this study mortality and morbidity were comparable with previous studies. On the other hand there wasn't any significant difference between results of this procedure and transthoracic approach that is used in other centers. Therefore it is recommended that transhiatal esophagectomy with appropriate selection of patients is the procedure of choice for curative and palliative means