Helicopter emergency medical system in a region lacking trauma coordination (experience from Tehran).

BACKGROUND: The helicopter emergency medical service (HEMS) has been working in Iran since 2000. The present study is the first prospective research to determine the epidemiological characteristics of injured patients transported by helicopter in Tehran. METHODS: All injured patients brought to three hospitals from the injury scene by HEMS were reviewed in a 4-month period. RESULTS: The mean transport time was 54 minutes. The most common mechanism of trauma was road traffic accidents (96.2%). The mean injury severity score was 8.6 (SD 8.6) and 9.6% of patients were sent to the intensive care unit; 10.2% of patients died. CONCLUSION: This study shows that overtriage in HEMS (transportation of patients without severe injuries) and the long transportation time is mainly a result of not having a trauma system. The study has shown HEMS to be an effective and feasible option in countries with heavy traffic and no trauma system.

Outcomes of the Rives-Stoppa technique in incisional hernia repair: ten years of experience.

BACKGROUND: Use of the Rives-Stoppa (R-S) technique has markedly diminished recurrence rate. Our aim was to assess the outcomes of Iranian patients undergoing the R-S technique and to determine factors affecting recurrence rate and time. METHODS: Over a 10-year period, 86 open abdominal wall incisional hernia repairs were performed using the R-S technique. Prolene and Mersilene meshes were used. Main outcome measures were the rate and time of recurrence and mortality. RESULTS: Sixty-six women and 20 men underwent the R-S technique (mean age: 51.21 +/- 13.01 years; mean follow up period: 67.60 +/- 32.55 months). The total recurrence rate was 5.8%. Most of these occurred in the first 12 months of follow up. Mersilene was used in 61%. There was no correlation between hernia recurrence and age, gender, defect size, mesh size, mesh type, number of meshes used, type of operation, position of incision, seroma, respiratory complications, ICU admission, or wound complications (P > 0.05). Overall postoperative complication rate was 18.2%. Except for type of operation, there was no correlation between the factors mentioned and recurrence time. Cumulative 5 and 10-year recurrence rate were 4.2 and 12.5%, respectively. CONCLUSION: The R-S technique is the most promising open technique, with low recurrence rates, excellent long-time results, and minimal serious morbidity. Age might be an important factor in recurrence rate.

Epidemiologic study of 284 patients with urogenital trauma in three trauma center in Tehran.

PURPOSE: To perform an epidemiologic study of urogenital injuries in traumatic patients who were referred to three traumatic centers in Tehran during one year. MATERIALS AND METHODS: This study included a part of data of National Trauma Registries, which was performed within one year. Questionnaires were completed by trained staff in three different geographical regions of Tehran: Shohada-e-Tajrish hospital (north of Tehran), Sina hospital (south of Tehran), and Shaheed Faiazbakhsh (west of Tehran). RESULTS: Two hundred and eighty four (5%) out of 57367 patients who were referred to the above mentioned centers had genitourinary trauma, of whom, 145 (42%) were hospitalized. Males with a frequency of 92% (258 patients) were the most injured group. Patients mean age was 25+/-14 years, mostly between 20 and 29 years (33.6%) followed by 10-19 years age group with a frequency of 25.6%. Non-penetrating trauma with a frequency of 96% was the most common type and accident was the most mechanism of trauma. One hundred and one patients out of the studied population had associated injuries. The most frequent injuries were occurred in extremities (40%) and the less in head and neck (7%). There were 22 (21.7%) intra-abdominal organ injuries. Sixty nine percent of patients developed mild injury (ISS<7), 20% developed severe injury and (ISS>12), and 4.2% of patients died. The most common injured organ was kidney (3.3%) and the least one was ureter, as no ureteral injury was reported. CONCLUSION: Although a low percentage of traumatic patients develop urogenital injuries, disregarding these injuries may lead to serious complications and it is recommended to consider these injuries while dealing with such patients. Considering the fact that these complications which could be preventable, are mostly developed in the youth, making solution for such problem is recommended.