Traumatic injuries in pregnant women: a case of motor vehicle accident for "ground round" discussion

The main objective for introducing this case study is to create a platform from which the importance of road traffic related injuries and traumas can be emphasized and discussed within and across various fields of investigation. The long term goal is to entice public campaign around unmet needs for higher road safety measures to reduce primary, secondary, and tertiary risks of injuries and traumas. a 28-year-old pregnant woman with a 16-week gestational age fetus was involved in a road car crash resulting in multiple traumas. Evaluation and treatment was initiated in the local Urgent Care Unit and continued in the emergency department and operation room. Patient underwent the following procedures: laparotomy, diverting colostomy, terminating pregnancy, right calcaneal traction and long leg splint, as well as multiple irrigation-debridements. Finally, the wound was left open and the patient was admitted to Intensive Care Unit. We hope that the introduction of this case for a "Ground Round" discussion will stir up a comprehensive discussion regarding the injury and trauma related preventive measures as well as treatment approaches in cases involving pregnant women in car accidents, and will bring about a holistic overview of this issue by the experts in various fields

[Post operation recurrence of inguinal hernia in children and its relation with suture material]

Using non-absorbable suture in children hernia repair to decrease of recurrence is recommended in the most pediatric surgery centers. The aim of this study was to determine relationship between kind of suture material and rate of hernia recurrence. In this clinical trial 200 children [age 1-5 years] with inguinal hernia who operated in Imam-Reza Hospital [kermanshah -Iran Between April 2007 until April 2008] enrolled into the study. Cases were selected by convenience sampling method and then randomly divided into two groups [100 cases per group] and operated with absorbable [silk 3-0] and non-absorbable [vicryli 3-0] suture material. Following period was 12 months after operation and collected data analyzed by statistical software. Emergency operations were excluded from the study. 83% of patients were boy and 17% were girl.%53 showed right side inguinal, 29% left side and%18 were bilateral hernia. After one year follow up only one case of recurrence was observed in each group. Our study confirmed that recurrence of inguinal hernia in children after surgery, is not related to kind of suture material [absorbability] and we didn't find any significant difference. Other factors than suture material may influence recurrence rate of hernia operation in children

[Report of 23 cases of choledochal cyst from two hospitals, Mofid and Taleghani in Tehran [1986-2004]]

Choledochal cyst is a congenital disorder of biliary tract. It is rare in western but more common in Asian countries. Most studies have been case reports but in this study for assessment of surgical method of treatment and late complications, patients were followed for 18 years. This retrospective study was done based on 23 patients profiles with diagnosis of choledochal cyst who have been admitted in two hospitals, Mofid and Taleghani in Tehran during 1986-2004. Diagnosis was based on imaging and intraoperative findings variables for assessment were age, sex, cyst type, clinical picture and surgical method of treatment. 70% of cases were female. Type I [sacular and fusiform, 74%] was the most common type, 70% of cases were between 1-5 years old, sonography was the most common imaging technic, that used for diagnosis [100% of cases], Icter was the most common clinical picture found in 70% of cases, surgical procedures and method in 70% of cases was standard and 30% of patients underwent palliative procedures. Although this study shows similarity in age, sex, common type, diagnostic and treatment methods with another centers and countries, but it shows necessity of surgeon's encouragement to use standard surgical method for decreasing late complications of disease

[Right - sided bochdalek hernia with ectopic kidney [a case report]]

Failure in the development of diaphragm leaves a posterolateral defect known as bochdalek hernia. This anomaly is observed on the left side in 80-90 percent of the cases. Incomplete development of the posterior diaphragm causes the abdominal viscera to move to the chest cavity, causing the lung to become hypoplastic at the affected side. Ectopic kidneys are mainly located within the pelvic. However rare cases of thoracic kidney have also been reported. The patient was a 2-months-old infant admitted to the pediatric ward in Kermanshah Imam Reza hospital. Chest x-ray and chest sonography revealed a right-sided diaphragmatic hernia with ectopic kidney within the right thorax. The patient underwent a surgery. It was a success and the patient was released from the hospital. Although thoracic kidney is a rare condition specifically when it is with diaphragmatic hernia, it could be diagnosed with before and after surgery investigations. This condition can be fixed with necessary manoeuvers and mobilization of vascular pediculus when the defect of diaphragm is removed