Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy

To determine the risk of postthyroidectomy hypocalcaemia by measuring parathyroid hormone [PTH] level after thyroidectomy. Cross-sectional study. Baqiyatallah Hospital, Tehran, Iran, from March 2008 to July 2010. All included patients were referred for total or near bilateral thyroidectomy. Serum Calcium [Ca] and PTH levels were measured before and 24 hours after surgery. In low Ca cases or development of hypocalcaemia symptoms, daily monitoring of Ca levels were continued. Data were analyzed using SPSS 20 software [SPSS, Chicago, IL, USA]. A p-value less than 0.05 were considered statistically significant. To assess the standard value of useful predictive factors, we used receiver operating characteristic [ROC] curves. Of total 99 patients who underwent bilateral thyroidectomy, 47 patients [47.5%] developed hypocalcaemia, out of them, 12 [25.5%] became symptomatic while 2 patients developed permanent hypoparathyroidism. After surgery, mean rank of PTH level within the normocalcaemic and hypocalcaemic patients was 55.34 and 44.1 respectively, p=0.052. Twenty four hours after surgery, 62% drop in PTH was associated with 83.3% of symptomatic hypocalcaemic. For diagnosis of symptomatic hypocalcaemia, 62% PTH drop had sensitivity and specificity were 83.3% and 90.80%. The area under the ROC curve for the PTH postoperative and PTH drop for diagnostic symptomatic hypocalcaemia were 0.835 and 0.873 respectively. Measuring PTH levels after 24 hours postthyroidectomy is not reliable factor for predicting hypocalcaemia itself. For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia

Major earthquakes of the past decade [2000-2010]: a comparative review of various aspects of management

This article sought to review and compare data of major earthquakes of the past decade and their aftermath in order to compare the magnitude, death toll, type of injuries, management procedures, extent of destruction and effectiveness of relief efforts. A retrospective study of the various aspects of management and / aftermath of 5 major earthquakes of the past decade [2000-2010] was undertaken. This included earthquakes occurring in Bam Iran, Sichuan China, Port-au-Prince Haiti, Kashmir Pakistan and lea Peru. A literature search was done via computer of published articles [indexed in Pubmed]. The issues assessed included: l]Local magnitude,2] Type of building structure 3]Time of the earthquake [day/time/season], 4]Time to rescue, 5] Triage, Transfer, and Treatment 6] Distribution of casualties [dead/ injured], 7]Degree of city damage, 8]Degree of damage to health facilities, 9] Field hospital availability, 10International aid, 11] Air transfer, 12] Telecommunication systems availability, 13] PTSD prevalence, 14] Most common injury and 15] Most common disease outbreak. The Bam earthquake had the lowest [6.6 Richter's] and the Sichuan earthquake had the greatest magnitude [8.0 Richter's]. Mortality in Haiti was 212,000 and it was the deadliest earthquake of the past decade. Collapse of heavy clay roofing structures was a major cause, of death in Iran and Pakistan. Earthquakes occurring at night and nonworking days carried a high death toll. The time to rescue and treat was the lengthiest in Haiti [possibly contributing to the death to injured ratio]. However, the worst dead to injured ratios were in Bam]51%] and in Pakistan [47%]; the best ratio was in China [15%]. Iran and Pakistan suffered the highest percentage of damage to the health facilities [90%]. Field hospital availability, international aid and air transfer were important issues. Telecommunication systems were best in China and worst in Pakistan. PTSD prevalence was highest in Iran. Respiratory infection was the most common infection following all 5 earthquakes. Earthquake damage, death toll, managerial protocols etc. vary in different countries and are influenced by many factors including the hour the earthquake hits and the day of the week. Additionally, social, structural and geographic factors as well as the medical, governmental and NGO respondents are influential. Engineered residential construction remains to be of importance in reducing mortality in developing countries. It is essential that hospitals, fire departments and police stations, water, telephone and electrical facilities be made earthquake proof

Management of treadmill hand injuries using soft tissue distraction

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a ; metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age. In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients. In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed. A total of 8 patients [3 girls and 5 boys] following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just l patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers. Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients

Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos

Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debride-ment and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention

Laparoscopic cholecystectomy versus small incision cholecystectomy in symptomatic gallstones disease

To compare the results and outcomes of the laparoscopic cholecystectomy [LC] with the small incision cholecystectomy [SIC]. Observational study. Baqiyatallah Hospital, Tehran, Iran, from February 2008 to March 2009. Patients with symptomatic gallstones that were referred and enrolled in the study for LC or SIC. Operation, anaesthesia, analgesics and postoperative care were standardized. The patients were assessed for operation time, postoperative pain, nausea, vomiting, hospital stay, return to work time and complications in the postoperative period on day 1, 1 week, 1 month and 6 months, postoperatively. Of 144 patients, 81 underwent LC and 63 underwent SIC. Both groups were matched for age, gender, BMI, clinical findings and ASA grading. The mean duration of operation was 74 and 62 minutes in the LC and SIC groups, respectively [p = 0.0059]. Duration of hospital stay and return to regular activities were shorter after LC compared to SIC. Pain scores, nausea and vomiting were the same in both groups, although the frequency of intra-operative complications were greater in LC compared to SIC. Outcome and complications of SIC were comparable with those of LC

Survival after in-hospital cardiopulmonary resuscitation in a major referral center

This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation [CPR], by the code blue team at our center to compare with other centers. Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests. Of the 290 patients included, 95 patients [30.4%] had successful CPR. However, only 35 patients [12%] were alive at discharge. The majority requiring CPR were above 60 years of age [61.7%]. Males required CPR more than females. There were 125 women [43.1%] and 165 males [56.9%] aged 3 to 78 [average 59.6] years. Majority [179] of the cases [61.7%] were above 60 years of age. Regarding the various wards, 54 cases [17.3%] were in the internal medicine ward, 63 cases [20.1%] in the surgery ward, 1 case [0.3%] in the clinic, 11 cases [3.5%] in the paraclinic, 116 cases [37.1%] in the emergency [ER], 55 cases [17.5%] in the Intensive Care Unit [ICU] and Coronary Care Unit [CCU], and 13 cases [4.2%] were in other wards. Cardiac massage was done in 133 cases [42.5%], defibrillation only via electroshock 3 cases [1%], and both were used in177 cases [56.5%]. The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases. In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge