Bulletin of Emergency And Trauma
Volume:2 Issue: 4, Oct 2014

To compare outcome of patients with burns covering less than 15% of total body surface area(TBSA) undergoing early excision and grafting or delayed skin grafting. This was a non-randomized clinical trial including 54 patients with less than 15% TBSA burn referring to Ghotboddin Hospital of Shiraz. They were assigned to two study groups, each group including 27 patients: the early excision and grafting group (EEG group) and the delayed grafting group (DG group). Patients were followed postoperatively for 6 months. Hospital stay, graft success rate, itching score and scar formation during 6 months of follow-up were recorded and compared between two study groups. During the study 1 patientwas lost to follow-up inearly excision and grafting group. Baseline characteristics were comparable between two study groups. The graft success rate was significantly higher in those patients who underwent early excision and grafting when compared to delayed grafting group (96.88% vs. 92.88%; p=0.033). However the length of hospital stay, itching and scar scores were comparable between two study groups after 6 months of follow-up. In patients with burns covering less than 15% TBSA, early excision and grafting is associated with higher graft success rates compared to the delayed excision and grafting. Howeverlength of hospital stay, itching and scar formation is comparable between the two techniques.

To determine the epidemiological characteristics of fatal traumatic accidents in patients referred to a hospital in Babol, Northern Iran. Thiswas a cross-sectionalstudy being performed during a 1-year period including all the dead trauma patients referred to ShahidBeheshtiHospital of Babol. We included all those patients who were transferred to our center to trauma and injuries and passed away during the hospital stay. Those who dieddue toelectrical shock, drowningandsuffocationcaused byhangingsandpoisoningwereexcluded from the study.Demographic information such as age, sex, marital status, education, employment, the type, location, and time of injury, injured parts of body and treatment methods, the cause, location and time of death were recorded. From the 92 dead patients, 76were men(82.6%) and16were women (17.4%). The cause of deathin 53 cases (57.6%) washead injury. Regarding the location,30patients (32.6%) diedat thesceneof the accident,62(67.4%) diedin the hospital. The maximum rateof trauma occurredin the afternoon shiftbetween the hours of13:30 to 19:30.The headand facewere themost damaged organs.Road traffic accidents were the most common cause of injury related mortality recordedin 81 patients (88.0%). Most of the accidentsoccurredinintercity roads in 27 people (33.3%) and the others inrural-urbanroads. Pedestrianswere the most common victims of road traffic accidents mortality being reported in 29 people (35.8%). Road traffic accidents are among the most common cause of injury related mortality in our region. Increasing the public knowledge and improve the traffic law enforcement measures should be considered for decreasing the morbidity and mortality.

To investigate the effects of intracranial pressure (ICP) monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury (TBI). This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period (from 2006 to 2010) including those patients with severe TBI who had undergone care based on ICP monitoring (case group) or clinical evaluation (control group).Patients and controls were matched regarding the age, sex, initial GCS, initial pupils, and CT findings. The functional outcome, complications and mortality rate were recorded and compared between those who underwent ICP monitoring and those who did not. There was no significant difference between two study groups regarding the baseline characteristics. The rate of meningitis was significantly higher in those who underwent Ventriculostomy and ICP monitoring when compared to those who were managed without ICP monitoring. [14 (23.3%) vs. 7 (11.6%); p=0.041]. We found that the mortality rate (28.3% vs. 11.6%; p=0.172) as well as the frequency of persistent vegetative state (5.0% vs. 5.0%; p=0.998) were comparable between two study groups. However the frequency of severe disability was higher in control group compared to case group (26.7% vs. 15.0; p=0.046). In the same way, the frequency of good recovery (26.7% vs. 15.0; p=0.046) and favorable outcome (51.7% vs. 33.3%; p=0.021) was significantly higher in case group. Care based on ICP monitoring in patients with severe TBI was associated with increased frequency of good recovery and favorable outcome and decreased frequency of moderate disability. However higher meningitis rate was associated with Ventriculostomy and ICP monitoring.

To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014). Data were retrieved from patients’medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29 ± 14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 5 gastric perforations (2.9%), 2 (1.15%) duodenal, 2 (1.15%) colonic, 2 (1.15%) sigmoidal and 2 (1.15%) rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13 ± 6 days. Overall mortality rate was 12.7%. Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors.

To determine the effects of topical administration of 20% oltipraz solution on histomorphometrical and stereological aspects of skin tissue in full thickness skin wounds in laboratory rats. Thirty-six male Wistar portion rats (220±20 g) were randomly divided into three groups (n=12). On the first day of experimentation, a 1-cm2 circular wound was made on the posterior surface of neck in all rats by removing a full thickness skin piece immediately after induction of anesthesia with ether inhalation. One group was treated with vehicle solution (DMSO alone). The second group was treated daily with 20% oltipraz solution, and the third group, the control group, received no treatment. The wound closure rate was estimated our previously described method. The volume density of collagen bundles, vessels, and hair follicles, the vessels’ length density, mean diameter of vessels and also fibroblast population were estimated by using stereological methods. The oltipraz group indicated a significantly higher improvement (6.26% of the wound surface per day) than control and the vehicle treated groups (p=0.032); furthermore, there was inconsiderable difference between the rate of wound closure in the group treated with vehicle (4.93% per day) and the control group (4.43% per day). Oltipraz has positive influence on fibroblast proliferation and re-epithelization. A noticeable observation in our study was absence of scar formation in wounds which were treated by oltipraz and can be mentioned as an advantage of this drug.

Syringobulbiais very rare condition defined as slit-like fluid cavity in the brain stem. Several conditions have been reported to be associated with syringobulbia including neoplasms, spinal cord traumas or lesions such as tethered cord, hind-brain herniation, infections such as meningitis and in isolation.Although post-traumatic syringomyelia has been wieldy described previously, traumatic brain injury has not been reported as the mechanism and etiology of isolated syringobulbia. We herein report a 24-year old man with previous history of severe traumatic brain injury who presented with recent onset inability to walk or coordinate movements, ataxia, dysphonia, dysarthria, bilateral third nerve palsy with fixed dilated pupils and eyes deviated outward and downward.He was further diagnosed to have isolated syringobulbia extending to upper pons and lower midbrain.Isolated post-traumatic syringobulbia is extremely rare condition presenting insidiously with cranial nerve palsies, ataxia and dysarthria.