Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation.

OBJECTIVE: One of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD. METHODS: Patients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications. RESULTS: Ninety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001). CONCLUSION: It seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.

Incidence of hepatocellular carcinoma in southeast iran.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is a well-known consequence of chronic liver disease (CLD). The aim of this study was to extract the HCC incidence rate in the province of Kerman, located in southern part of Iran, and compare the data with other parts of the country. MATERIALS AND METHODS: All medical records related to HCC were collected through hospitals or outpatient services in public or private centers. The records of all oncology, radiotherapy, and pathology centers in Kerman province were actively searched between 1999 and 2006. The annual incidence of HCC around the country was calculated, using the national cancer registry database provided by the Health Ministry of IR Iran from 2005 to 2006. Using Stata version 8, the crude and age-sex-standardized annual incidence rates were computed. RESULTS: The crude annual incidence rates of HCC per 100,000 persons in Kerman and Iran were 0.522 (95% CI = 0.238- 0.88) and 0.199 (95% CI = 0.167-0.234), respectively. When adjusting for age and sex, the annual incidence rates of HCC in Kerman and Iran were 0.7 (95% CI = 0.4-1.1) and 0.2 (95% CI = 0.2-0.3) per 100,000 persons, respectively (P<0.01).The mean age of patients in Kerman was around 5.5 years younger than other parts of Iran (56.17 ± 18.32 years versus 61.68 ± 14.62 years; P=0.004). CONCLUSIONS: In general, the incidence of HCC is not very high in Iran; however, the higher incidence of HCC in Kerman and also the lower age of onset mandates further research to detect HCC's risk factors in this part of country.

Earthquake related injuries: assessment of 854 victims of the 2003 Bam disaster transported to tertiary referral hospitals.

BACKGROUND: In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. OBJECTIVE: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran. METHODS: The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed. RESULTS: There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value +/- SD for ISS was 6.7 +/- 5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14). CONCLUSIONS: Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.