[Management of blunt hepatic trauma in patients referred to Isfahan Alzahra hospital during 1998-2008]

Liver is the most commonly injured organ in blunt abdominal trauma. Early diagnosis and appropriate treatment of blunt hepatic trauma would decrease morbidity and mortality rates. To achieve this goal, physicians should be aware of the prevalence, etiologies, signs and symptoms, diagnostic procedures and up-to-date management of blunt hepatic trauma. A descriptive retrospective study was conducted on all 130 patients admitted to the emergency department of Isfahan Alzahra Hospital during 1998- 2008. Data were collected from patients' medical records and analyzed using descriptive statistical methods. Out of 130 patients, 103 cases [79.2%] were male. Mean age of cases was 29.7 +/- 13.46. The most common traumatic mechanism was vehicle accidents in 100 cases [76.9%]. Sonography in association with CT scan as the most commonly used diagnostic method was obtained in 68 cases [52.3%]. Eighty-eight cases [67.7%] underwent surgery while conservative treatment was selected for the other 42 cases [32.3%]. Admission to ICU was more frequently needed in conservative treatment group [P=0.001]. The mean length of hospitalization was shorter for patients underwent surgery. Better clinical results and fewer complications in the group managed conservatively presents it as a safer and more efficient treatment method

Liver transplantation in the presence of old portal vein thrombosis

Portal vein thrombosis [PVT] has been mentioned as a potential obstacle to liver transplantation [LTx]. To review the impact of PVT on orthotopic liver transplant [OLT] outcome. Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 [7.9%] cases had old PVT with recanalization. Data were retrospectively collected regarding the demograph- ics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary scle- rosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean +/- SD op- eration time was 7.2 +/- 1.5 hrs. The mean +/- SD transfusion requirement was 5.4 +/- 2.8 units of packed cells. The mean +/- SD duration of hospital stay in these patients was 17.7 +/- 10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular ac- cident, despite a full anticoagulant therapy. The mean +/- SD follow-up period for those 28 patients discharged from hospital was 16.6 +/- 7.9 months; none of them developed relapse of PVT. The overall mortality and mor- bidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients. The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality

[ efficacy of dexamethasone on post-cholecystectomy nausea and vomiting]

Nausea and vomiting are among the common complications of anesthesia and surgery with a higher incidence in laparoscopic cholecystectomy [LC]. The purpose of this study was to evaluate the efficacy of pre-operative dexamethasone on the relief of postoperative nausea and vomiting following LC. This is a randomized clinical trial study. In this prospective, placebo-controlled study, 90 patients requiring laparoscopic cholecystectomy [LC] were randomly divided into two groups: the dexamethasone group [n=45] received dexamethasone [8 mg, IV] and the control group [n=45] received saline [2cc, IV] 90 minutes before the anesthesia. Signs and symptoms of nausea and vomiting were recorded every 4h for 16h in the two groups. The data were analyzed using Fisher's, Chi-square and t test. A lower feeling of nausea was seen 4h and 12h post-surgery in the dexamethasone group [P=0.02, P=004], also a lower accurance of vomithng was observed 4h post-operative in the same group compared to the control group [P=0.013]. The results suggest that pre-operative dexamethasone [8 mg, IV] application significantly reduces the incidence of post-operative nausea and vomiting

[Prediction of trauma outcome with platelet count]

The relationship between the number of platelet and the outcome of trauma is not clearly known. The purpose of this study was to determine the relationship between the number of platelet and the outcome of trauma in traumatic patients [Abdomen and chest] referred to hospital and mortality and morbidity rates after trauma. This deh1ive-analytical study was performed on 300 patients with torso trauma admitted in Al-Zahra hospital in Isfahan Iran in 2005. Injury Severity Score [ISS] complete Blood Count [CBC] and platelet count were measured from all the patients at their arriving to the hospital. We also evaluated the patients for the duration of hospitalization need to stay in ICU duration of ICU care thrombo-embolic events such as deep vein thrombosis [DVT] and respiratory emboli and finally for the outcome of the trauma [death or recovery]. Data were analyzed using student t-test Chi-square and regression. The mean age of patients was 32 +/- 17.51 years from those 78% were men. We found a direct significant relationship between the duration of hospitalization and platelet count and ISS [P0.05]. Our findings suggest that platelet counting in traumatic patients at the beginning of their hospitalization is a good predicting factor to estimate the duration of the hospitalization

[ evaluation of tubule formation in breast cancer using fraction of fileds showing tubular differentiation [FTD] method and compare it with conventional methods]

Histological grading is one of the most important prognostic factors in breast cancer. So far, there has not been any available method for quantitative estimation of tubular differentiation. Therefore, this study was aimed to evaluate the experimental and conventional method and compare the reproducibility of it with the other quantitative and semi-quantitative methods using 200 morphometric microscopic magnifications. In this descriptive-analytical study which, conducted in 2006, a total of 38 histological samples of breast invasive ductal carcinoma were selected of 38 histological samples of breast invasive ductal carcinoma were selected and tubular differentiation was assessed by two pathologists using three methods. The first method [conventional], the rate of tubular differentiation [a portion of tumor with malignant tubules] to the total sample calculated and shown in percentage. The second one, was the fraction of fields showing tubular differentiation [FTD], and the third one was the subjective evaluation of each field and then considering the mean of all fields. Using Friedman test, the difference between the 3 methods was compared and Kappa test was used to compare the reproducibility of each method between the two observers. The results showed that using the second method, the scoring of the samples by the two observers was almost the same. It means that Kappa indices in the first, second, and third method was 0.4, 0.832, and 0.558, respectively [p<0.001]. Also, Friedman test showed that there was statistically significant difference between the findings of each of the observers in any of the 3 methods used [p<0.001]. Base on the results, FTD has higher reproducibility than that of other two methods. Thus, it can be used as a simple method in assessment of tubular differentiation

Comparison of histopathologic findings of non-tumoral gastric mucus of patients with gastric cancer and patients with chronic gastritis

Gastric cancer is the second cause of cancer death throughout the world. Identification of precancerous lesions is important for designing preventive measures. Therefore, the aim of this study was to evaluate the correlation between lesions and the cancer. Histological findings of 55 patients with gastric cancer including atrophy, intestinal metaplasia, dysplasia, gastric grade, lymphoid follicles, infiltration of eosinophil and presence of H. pylori were compared with those of the patients with chronic gastritis without any tumor or ulcer. The data was analyzed using Chi-square, Mann-Whitney and Odds ratio tests. There was no statistically significant difference between the two groups with respect to atrophy, infiltration of eosinophil and lymphoid follicle. The frequency of intestinal metaplasia [OR: 19/89], dysplasia [OR: 76/22] and lymphoid follicule [OR: 22/46] in the case and control groups was 47.3% and 10.9% [p<0.001], 14.5% and 1.8% [p<0.01], 81.8% and 32.7% [p<0.001], respectively. The frequency of severe and moderate chronic gastritis in control group was more than that in the case group [p<0.05, OR: 0.93]. There was strong correlation between gastric cancer and dysplasia, intestinal metaplasia and lymphoid follicles. Therefore, the presence of such lesions in the gastric biopsy is alerting and these patients should be checked up regularly