فهرست مطالب مهرداد حسین پور

Hirschsprung's disease (HD) is a congenital absence of ganglion cells. Due to the lack of consensus about the possibility of relying on the histology of the appendix to diagnose HD, appendectomy and sampling of the appendix are still performed in many centers in Iran and the world to diagnose it. This study aimed to evaluate the possibility of partial appendectomy and prevent total appendectomy to diagnose HD and determine the prevalence of aganglionosis in each part.

The present study was a prospective cohort study. The study population consisted of patients under 16 years of age in need of appendectomy who were referred to Isfahan teaching hospitals from March 2022 to March 2023. The inclusion criteria were age below 16 years and undergoing appendectomy with the diagnosis of appendicitis based on the Alvarado criteria, and the exclusion criteria were perforated or gangrene appendix and appendix neoplasia. The research variables included age and gender (as background variables) and the number of ganglion cells in each hpf (as dependent variable).

The average age of the examined patients was 8.84 ± 3.33 years. 58% of the patients were male. The total number of ganglion cells seen in the entire slide containing the samples was the highest in the middle and the lowest in the distal slides, which were significantly different (P = 0.038).

The middle part of the appendix has the highest number of ganglion cells and is the best part for biopsy for the HD diagnosis.

Intraoperative fluid therapy is to ensure adequate injection of maintenance fluids including electrolytes and glucose to replace fluid deficiency during surgery. Given that there is still no consensus on fluid therapy in neonates, the aim of this study was to evaluate the use of normal saline serum and one fifth-four fifths serum in neonates who are candidates for surgery. 

In a randomized clinical trial study, 72 neonates who were 1- 30-days-old and candidates for surgery, admitted to Imam Hossein Hospital in Isfahan were divided into two groups. Fluid therapy was randomly administered using normal saline or one-fifth-four-fifths fluid in each group. Biochemical and hemodynamic variables such as blood sugar, sodium, pH, bicarbonate BE, heart rate and mean arterial pressure were assessed preoperatively and postoperatively.

Post-operative blood glucose levels after 60-minutes at The Neonatal Intensive Care Unit (NICU) for the normal saline group were 152.56, 148.47 and 155.61 mg/dl, respectively, while in one fifth–four fifths solution group were 242.78, 197.28, 278.19 mg / dl, respectively, which showed a significant difference between the two types of solutions. There was also a significant increase in blood sugar compared to pre-operative states. Mean pre-operative plasma sodium levels showed a significant increase for the normal saline group and a significant decrease for the one fifth-four fifth group.

One fifth- four fifths solution owing to hyperglycemia and hyponatremia is not a suitable choice for intraoperative fluid therapy in neonates. In contrast, normal saline solution performed better in controlling blood sugar and plasma sodium.

Congenital malformations are one of the causes of infants disability and death. this study was performed to determine the incidence of major congenitals anomalies and their relationship with some related factors at birth.

In this cross-sectional study, all newborns born in hospitals of Chaharmahal va Bakhtiari province were evaluated for major congenital malformations at birth. information recorded in the case file including parent and infant characteristics was extracted from the mother and infant system. data were analyzed using Generalized Linear Model, family (poisson).

Of the 19666 newborns studied, 63 (3.2 per 1,000) had major congenital malformations at birth. in the crude model, pregnancy age, neonatal birth weight, neonatal height, and neonatal head circumference variables were significantly associated with congenital malformations. but in adjusted model 1, residence was significantly related to the incidence of congenital malformations and in adjusted model 2, the incidence of congenital malformations was related to neonatal pregnancy age, neonatal birth weight and neonatal head circumference.

Some of MCAs with early diagnosis and treatment can prevent disability. Therefore, the emphasis on public education to consider appropriate gestational age, proper nutrition before and during pregnancy, emphasis on prenatal and prenatal care is necessary to prevent congenital anomalies.

The aim of this study was to evaluate the calretinin and nitric oxide (NO) immunohistochemical (IHC) staining in ganglionic segment of colon of children with Hirschsprung's disease (HD).

 In a cross-sectional study, 60 children with HD entered the study, and underwent surgery to pull out the bowel from the anus to take biopsy from every 5 cm. Hematoxylin and eosin (H&E) and IHC methods were evaluated, and the results were reported to be poorly positive or severely positive for calretinin. All patients were followed up 1 and 6 months after the operation, and the results were compared between the two groups.

 From 60 children with HD, 14 patients (23.3%) were symptomatic. In 14 symptomatic patients, all colorectal samples from ganglionic segments were negative for NO staining in comparison of placental NO staining as sham group. In the IHC examination, nuclear and cytoplasmic calretinin staining revealed ganglion cells in 52 patients as strongly positive, and weakly positive in 8 patients. Six patients in strongly positive group (11.5%) were symptomatic, while 8 patients whose calretinin staining was reported as weakly stained, had symptoms (P = 0.001). Overall accuracy of prediction of postoperative constipation for calretinin staining was 96.67%.</div>

 According to the findings of our study, it seems that in children with HD who undergo surgery, proximal ganglion immunohistochemical staining may be effective in determining postoperative bowel dysfunction.

Congenital anomalies are also known as birth defects and congenital disorders. Congenital anomalies occur in about 3-7% of the newborn babies worldwide. The purpose of this study was to determine the incidence of congenital anomalies and their determinants in hospitals affiliated with Isfahan University of Medical Sciences in 1395.

This cross-sectional study was conducted in all infants born in 1395. The data were analyzed with the SPSS software version 20 using Binary logistic regression.

Of 5455 births in Isfahan hospitals, 121 neonates were diagnosed with major congenital anomalies. The total incidence of major congenital anomalies was 2.2 per 100 births. The results showed a statistically significant relationship between maternal blood group, consanguinity, sex and height of infant with congenital anomalies in newborns (P <0.05). Moreover, 26.7% of all abnormalities were related to limbs and the lowest percentage was related to genetic abnormalities, digestive system, anus, and spine with an incidence of 0.7% for each.

More attention should be paid to premarital genetic counseling in order to identify the consanguinity factor as a risk factor for genetic abnormalities. Moreover, pregnant women should be educated about the timely intake of micronutrients to control abnormalities.

This study aimed to investigate the changes of serum zinc in term neonates who need major operation. In this study, 59 neonates who need major operation were studied. All patients underwent major surgical with high stress. The metabolic response to surgery was studied by measuring the serum zinc before and after surgery (24 hours and at discharge time postoperatively). The "repeated measure" analysis was used to test changes of plasma values of zinc over time.  The plasma values of zinc was 89.78±14.50 µg/dl after surgery, 74.95±15.86 µg/dl in 24 hours after surgery and 93.78±14.53 µg/dl at discharge. The plasma values of zinc decreased immediately after surgery that this decline continued until the first 24 hours of operation. Serum zinc concentration decreased significantly at 24 hours at discharge. No significant differences were found between the two sex groups. According to the results of this study, zinc levels in term neonates who need major operation were decreased temporary but later returned to normal. It seems that in these patients there is no need for supplementation of zinc during two weeks after operation.

Despite great advances in the field of surgery, the control of liver parenchymal hemorrhage is still one of the challenges surgeons face in saving the patients’ lives. Aluminum sulfate is used as a hemostatic agent in dental surgery. This study aimed to examine the hemostatic effect of aluminum sulfate on controlling bleeding from liver parenchymal tissue. In this experimental study, 60 male Wistar rats were randomly allocated into six equal groups of 10 mice each. An incision (2 cm length; 0.5 cm depth) was made on each rat's liver surface and the length of time to hemostasis as a dependent variable was measured using different concentrations of aluminum sulfate (5%, 10%, 15%, 25%, and 50%) against the control method (control of bleeding by suturing) as the independent variable. The liver tissue was examined for pathological changes. The length of time to hemostasis in the aluminum sulfate groups was significantly less than that of the control group (P<0.01). The pathologic examination showed the highest frequency of low-grade inflammation based on the defined pathological grading. Aluminum sulfate is an effective hemostatic agent with low-grade inflammation effect in controlling the bleeding from liver parenchymal tissue in an animal model.

Introduction & Urinary catheters are different and each one is made for a specific purpose. Some patients have urinary catheters for long stays in their bladder، so its complications must be evaluated. In this study، the effects of two types of urinary catheters on the rabbit bladder pathology were compared. It this study a total of 20 New Zealand rabbits were randomly divided into 2 groups of 10 rabbits. Under general anesthesia، and following a lower midline incision، bladder was exposed and in groups 1 cystostomy with Nelaton catheter in 10 rabbit was performed and 10 other rabbits in groups 2 were placed under Systostomy with Foley catheter. 7 days after the surgery، a re-laparotomy with isolation of rabbit bladder tissue was performed for pathological assessment. All data extraction was done by 17. 0 SPSS software. Statistical tests such as Chi-square، Fisher''s exact test، and Mann-Whitney tests were used for data analysis. P-value ≤ 0. 05 was considered significant. In both the Foley and Nelaton catheter groups، the highest frequency intensity in inflammation was of grade 3. Although the group with a Nelaton catheter had more inflammation than Foley catheter group but this difference was not significant (P > 0. 05). The samples of inflammatory cells were different from 5 to 80 percent. In Nelaton and Foley catheter groups، the highest frequency of five to ten percent of PMN was seen. The difference between the two groups in the mean severity of bleeding was not significant (P > 0. 05). Foley catheter had less chance of infection than Nelaton catheter. Although the differences observed in the two groups was not significant in the chi-square test (P > 0. 05). A comparison of the severity of inflammation، inflammatory cells، bleeding in the tissues of the bladder in pathological assessment and urinary tract infection demonstrated no significant difference between Nelaton and folly catheters. This indicates that none of the above two types of catheters had any particular preference.

Introduction & The control of external bleeding، despite progresses in surgical science، is still one of the challenges surgeons face in saving patients’ lives. There is a research contest among the researchers in this field to introduce a more effective method. This study attempts to determine the hemostatic effect of ferric sulfate in controlling external bleeding. In this clinical trial 60 male Wistar rats were used. A 2-centimeter incision was made on each mouse’s skin and the hemostasis time was measured، using ferric sulfate with different concentrations (5. 0%، 10. 0%، 15. 0%، 25%، and 50%) and the control method (i. e. control of bleeding by suturing). The skin tissue was assessed for pathological changes. Finally، the obtained data were entered into SPSS software and were analyzed by using Kruskal-Wallis test، Mann - Whitney، Kolmogorov – Smirnov test and also Wilcoxon signed ranks test. The hemostasis time of ferric sulfate concentration groups was significantly less than that of the control group (P-value < 0. 001) and the pathologic examination showed the most frequency of low grade inflammation، based on the defined pathological grading. Ferric sulfate may be an effective hemostatic agent in controlling an external bleeding in mouse.

Introduction & The neutrophil-lymphocyte ratio test has extensive application in diagnosis of appendicitis، but its accuracy has some contraversies. According to the importance of this disease and to determin the efficiency of this test، this study was done on adults who referred to Shahid Beheshti hospital of Kashan in 2008، with diagnosis of appendicitis. In this descriptive-analytic study، blood for measurement of CBC & diffrentiation was collected pre-operatively from 106 patients. The patients according to the histopathology of the appendix were divided in two groups; to positive (acute and complicated Appendicitis) and negative (normal) and the ratio of Neutrophiles to Lymphocits، compared in two groups. In this study، 106 patients with suspicious diagnosis of acute appendicitis were studied. Out of a total 106 patients، 94 patients (88. 7%) had positive appendicitis. WBC count was 12798±4181 mm3 in positive appendectomies and 10561±5699 mm3 in negative group (P=0. 03). Neutrophil percent was 80±36 % in positive group and 66 ±11% in negative group (P=0. 005). Lymphocyte percent was 15±9% in positive group and 24 ±11% in negative group (P=0. 013). Neut/Lym ratio percent was 7±5 in positive group and 4 ±3 in negative group (P=0. 01). Neut/Lym ratio /8% were males and 38. 1% were females، Male to female ratio being 1. 6:1. On histological examination، 86. 9% had acute appendicitis whereas 13. 1% had normal appendix. Sensitivify، Specificity، Positive predictive Vulue and negative predictive value of Neut/Lym ratio test was respectively: 74%، 67%، 94%، 25% the area under the ROC Curve was 0. 730. The Neut/Lym ratio test، in spite of significant difference doesn''t have necessary efficiency in diagnosis of acute and complicated appondicitis.

There are different surgical procedures for circumcision. Although the classic method is the most common one, it takes more time and causes more pain and complications compared to other methods. The purpose of this study was to compare the complications and the time taken for performing the surgery for Gomco and classic methods of circumcision.

This case-control study was performed on 80 neonates referred to the outpatient operating room in Shahid Beheshti hospital for circumcision in 2011 and were divided into two equal groups: one group underwent the classic method and another, the Gomco method. The complications were assessed in two phases: during the surgery by counting bloody gauze pads and one week thereafter using the objective methods, then they were analyzed statistically.

The mean age of neonates was 24.8±12.37 days and no significant difference was seen between two groups. The mean operation duration in the classic method (24.3±2.5 min) was approximately two times greater than that of the Gomco method (13.3±2.3 min). Moreover, the amount of bleeding in the classic method (4.1±0.6 cc) was over three times greater than that of the Gomco one (1.3±0.7 cc). No cases of infection were seen in both groups.

Results show that the Gomco method takes less time and causes less pain and fewer complications compared to the classic method and may also be a suitable alternative to the classic method.

Intussusception is the telescoping of one portion of the intestine in to another. The appropriate treatment can reduce the complication, mortality and morbities. The first line of non surgical treatment is contrast enema. This study was done to identification the clinical and laboratory predictors of successof barium enema. This was a cross-sectional study that considered all the children with intussusceptions, who were refered in 2009 and 2010 to Alzahra hospital, Iran. All of the needed information including age, sex, fever, leukocytosis, free fluid in sonography, time of symptom appearance and positive bloody stool was recorded in a questionnaire. Then we committed Barium enema for all of them, and evaluate the relationship between the success of barium enema with gathered data by chi square and Student t-test. In this study we evaluated 45 children with intussusceptions. In 18 subjects the barium enema treatment was success. The results of this study showed a significant correlation between positive blood stool and free fluid in sonography with unsuccessful of barium enema treatment. According to our results in children with bloody stool or free fluid in sonography we recommend only one time barium enema. If the treatment is unsuccessful, it is better to advise patients for open surgery.

Mesenteric ischemia is a potentially life-threatening disorder; however, there is still no exact diagnosis for it. This study was designed to evaluate pH value and potassium level of DPL for diagnosing mesenteric ischemia in the afflicted rats. Methods and Materials: In this experimental study, 32 rats were divided in four groups (8 rats in each group). In groups 1 and 2 abdomen was opened and closed without any medical interventions then through a catheter they were injected 200cc of normal saline intraperitoneally. In group 1 after one hour and in group 2 after two hours the liquid was lavaged for determination of potassium and pH values. A blood sample was also prepared for determination of potassium. In groups 3 and 4, after anesthesia, the main branch of the superior mesenteric artery was ligated with a non-absorbable suture and the animals were introduced to the procedures just mentioned. Mesenteric ischemia led to varied peritoneal pH and blood as well as peritoneal lavage potassium between the two groups. Only blood/peritoneal potassium level showed a significant difference after 2 hours of mesenteric artery ligation. Peritoneal pH and blood/peritoneal lavage potassium can be used as an indicator of mesenteric ischemia. Blood/ peritoneal potassium level may also be helpful to predict the duration of mesenteric ischemia.

Accidents are the leading cause of emergency room admissions and mortality for children below the age of 15. This study evaluate overall epidemiological information of pediatric trauma in children referred to Isfahan Alzahra Hospital. This cross-sectional study included 2300 children admitted to Alzahra Hospital emergency room during 2005-8. Data including age, sex, kind of trauma, site of injury, blood pressure and cause of death were recorded in prepared checklist by the study of hospital files. Female to male ratio was 2:1 (66.7% versus 33.3). Most of the events (45%) happened at home and school. Fall (32%) followed by motor vehicle accidents (31.1%) were the most common mechanisms of trauma. The most common areas injured in pediatric multiple trauma victims were head (34.3%) and limbs (18.9%). Mortality rate was (4.1%). Falling down and traffic accidents are very common in pediatric emergencies. Training the parents to believe that their children are in need of protection and surveillance is the most effective program of decreasing trauma-induced mortality in children.

Introduction & Direct access to blood circulating system specially superficial veins in some emergency situation such as severe burning, severe edema, thrombosis in superficial veins, severe obesity and shock due to severe bleeding is difficult and in some cases impossible. So, in such situations other routes of injection should be used for fluid and drug infusion. In this study, the two routes of intravenous and intraosseous injection were evaluated in the case of adult rabbits with mature bones. This study was carried out, as an experimental study, on 20 adult white New Zealand rabbits with 4-6 month age. Methylen-blue was used to compare the two ways of intravenous and intraosseous injection, 10 rabbits received 5cc Methylen-blue intravenously and 10 rabbits received 5cc Methylen-blue intraosseously. Data were collected and analyzed by using appropriate frequency tables for the available data. The average time of Methylen-blue appearance in the Aortic cannulation was 9.781±2.336 second for intraosseous injection and 10.052±2.336 seconds for intravenous injection. The difference was not statistically (Man Whitney) significant (P=0.800). It is seems that intraosseous injection has the same efficacy as the intravenous injection and we can use intraosseous injection route in adults when the vein is inaccessible.

Foregut duplication is commonly found in the posterior mediastinum. About 10-20% of these anomalies are associated with esophageal duplication. It can occur in all parts of esophagus. Although the duplication of cervical esophagus has been previously reported, a majority of it was found in the thoracic oesophagus. Infant esophageal duplication is usually associated to respiratory distress or asymptomatic thoracic mass, casually detected in x-ray. Case Report: In this report the case was a 7 months old infant (7.5 kg) with the chief compliant of respiratory distress, fever and nutritional intolerance. Physical examination of the case showed dehydration, stridor, tachypnea, intercostal retraction and neck stiffness. Plain chest radiogram showed a dual cystic mass in the distal neck region. Neck and chest CT- scan showed cervical cystic lesion disseminated to the posterior mediastinum, probably propagated to the respiratory system. For treatment, cystic lesion attached to the esophagus was partially resected, esophagus was repaired and the remaining mucosa of the cyst was removed, then gastrostomy tube was inserted. Although the cervical esophageal duplication of cysts are rare in infant respiratory distress, they must be considered as one of differential diagnoses of the cervical masses.

The use of synthetic mesh for the repair of major congenital diaphragmatic hernia may cause visceral adhesion to prosthesis and ongoing complications. In present study the use of propylen mesh for the repair of diaphragmatic hernia and its role in eliminating of visceral adhesion to repair site is evaluated. This experimental study was carried out on 20 adult New Zealand rabbits (age: 6 months) assigned randomly into two equal groups. In one group, after laparatomy a defect (size: 1×1 cm) was created on the diaphragm. The suture was then repaired by sterile propylen mesh and nylon suture (thickness: 3/0 - 4/0). In another group, omentum was fixed on the mesh using a nylon suture (thickness: 3/0). After 30 days the two groups were operated and the visceral adhesion to repair site was compared using Mazuji scale. Nine (90%) out of 10 rabbits with propylen mesh repair had visceral adhesion to the repair site. On classifying the grade of adhesion among the cases, one, three, four and two rabbits were assigned the “0”, “I”, “II”, and “III” grades, respectively. On the other hand, 4 (40%) out of 10 rabbits, in which the diaphragm was repaired by propylen mesh and omentopexy method, visceral adhesion (grade “I”) was seen to the site of repair. The rest of animals displayed no such adhesion. Omentopexy reduces the visceral adhesion to propylen mesh.

Surgical procedures including open and close lateral sphincterotomy were the main treatment of chronic anal fissure in past years. Nowadays medical treatments are the standard therapy for this disease but there are some limitations for this method of treatment. This study aimed to compare the efficacy and complication of surgical and medical treatments by lidocaine ointment for patients with chronic anal fissure A clinical trial study was conducted on 180 patients with chronic anal fissure who had symptoms for more than 6 weeks. The main symptoms of patients were pain during defecation anal bleeding and skin tag. After history taking and physical examination method of treatment was explained for patients to choose one group: Group 1 (surgery) or group 2 (medical treatment with lidocaine H). Surgery was performed by closed method. Medical treatment was consisted of high fiber regimen sits baths lax tablet nightly Naproxen tablet 250 mg twice daily and 5% lidocaine anal application before defecation and anal washing during defecation. Patients were followed for 8 weeks. Data were analyzed using chi-square Fisher and Mann-Whitney tests. one hundred of patients in group 1 and 80 patients in group 2 completed the study. Duration of symptoms was 8.1±2.5 weeks in group 1and 7.9±3.1 weeks in group 2. Post operative complications in group 1 were skin ecchymosis (10%) large hematoma (2%) and 10 cases (10%) complained from mild incontinency to flatus. There was no complication in group 2. Healing rate was 93% in group 1 and 75% in group 2 (P

Introduction & Acute appendicitis is one of the most common surgical emergencies. The main step in the of diagnosis of appendicitis is: accurate history, clinical evaluation and physical examination. Because to increase of C-Reactive protein in inflammation states, and the fact that the decrease of negative appendectomy can lead to the decrease of morbidity and mortality and hospital's costs, the diagnostic value of high - sensitive CRP, in the care of acute appendicitis has been evaluated in this study. In a descriptive - analytic study, blood for the measurement of serum c-reactive protein was collected, pre – operatively, from 84 patients, who had appendectomies at the Shahid Beheshti hospital. The histopathology was grouped into positive (acute appendicitis) and negative (normal appendix) and this was correlated with the CRP values, that were measured with ELISA. Receiver operating curve was constructed for CRP and the best cut off point was used to calculate sensitivity and specificity of the test. In 84 patients, 61/8% were males and 38.1% were females, the male to female ratio being 1.6: 1. On histological examination, 86.9% had acute appendicitis whereas 13.1% had normal appendictis. The cut off value of high sensitive -CRP was 31.48 g/ml (P=0.049). The area under curve (AUC) was 0.699. The sensitivity and specificity of CRP was 90% and 20% respectively. High sensitive CRP can be used to support the clinical diagnosis of appendicitis, thus unnecessary removal of normal appendix may be reduced.

Pseudoaneurysm is a relatively common vascular disease which may occur despite the technological advances and excessive use of femoral artery catheterization (therapeutic and diagnostic). The aim of this study was to determine the therapeutic complications and consequences of femoral artery legation compared to other procedures applied for trauma-induced infectious pseudoaneurysms. Through a cross-sectional study, all patients with infectious femoral artery pseudoaneurysm referring to hospital during 2006-7 were included. To collect the data, checklists consisted of questions about age, sex, patients’ chief complaints, clinical signs, organ paresthesia, edema, purulent discharge, subcutaneous emphysema, pulse, aneurysm site, presence or absence of concurrent venous involvement and/or artriovenous fistula, way of aneurysm repair, the extent of debridement, and clinical manifestations of the limb after surgery. On a 6-month postsurgery follow up all data were recorded in related checklists. Thirty-three pseudoaneurysm patients were studied. The mean age of the cases was 34/31± 11/36 years. Pain was among the patients’ chief complaint. Major sign of the disease on physical examination was: palpable mass pulsating in 57.6% and non-pulsating in 15.2% of cases. For 81.8%, 9.1%, and 9.1% of the cases, arterial legation, excision, and arterial bypass were done, respectively. While none of the patients undergoing arterial excision and bypass had gangrene, 12.5% of the cases undergoing artery legation had gangrene and lower limb amputation. Twenty percent were positive for HCV, 28% positive for HBS and 11% positive for both HCV and HBS. In addition, 10% of the patients were positive for HIV. Considering the more convenient and available technique of arterial legation and also taking into account of the fact that only 10% of the patients need vascularation after legation, surgery of femoral artery legation, particularly in patients with infectious pseudoaneurysm is recommended.

As trauma is the leading cause of mortality and related complications in Iran, colon rupture and injury during trauma is of much importance as well. In present study through a three-year epidemiological study, cases of colon ruptures and injuries along with the diagnostic and therapeutic approaches in Isfahan Al-Zahra and Kashan Shahid Beheshti hospitals were reviewed. During a three-year period (2007-9), a number of 28 patients with post-traumatic colon ruptures were studied in two educational hospitals of Isfahan and Kashan. This retrospective survey was based on the patients’ medical records. Collected data was included of sex, age, cause and site of rupture, clinical manifestations, type of surgical treatment, mortality, and length of hospital stay. Fourteen patients (50%) had penetrating and another 14 ones (50%) blunt traumas. Mean age for the penetrating and blunt traumas were 26/21 ±11/98 and 35/07 ±16/8 years, respectively. The most reported injury sites were sigmoid and transverse colon for blunt and penetrating traumas, respectively. Colostomy with or without repair has often been performed for the penetrating traumas. One penetrating trauma case (7/2%) and 5 blunt trauma cases (35/7%) have deceased in the hospital. In terms of the severity of peritonitis, in penetrating trauma patients, 10 cases (71/4%) and 4 cases (28/5%)) were in stage I and stage IV, respectively, but for blunt traumas, 12 cases (85/7%) and one case (7/2%) and one case (7/2%) were in stage I, stage III, and stage IV, respectively, with no significant difference between the two groups. Average length of hospital stay was 13/07±7/97 (range 6-28) days for penetrating traumas and 11/71±9/8 (range 6-40) days for blunt traumas, with no significant difference between two groups. Summing up, the study demonstrates that cases of post-traumatic colon rupture are in accordance with other causes of colon rupture in terms of mortality. In spite of the suggestions of reference texts and regarding the lower severity of the peritonitis, in most penetrating traumas, surgeons still resort to colostomy as a supporting factor for repairing or even as an independent treating approach.

Introduction & The aim of this study is comparison of the effect of subcutaneous injection of bupivacaine 0. 5% before and after appendectomy on the pain after surgery. A clinical trial randomized single-blind study was conducted on 150 male patients with preoperative tentative diagnosis of acute appendicitis. They were randomly divided into there groups. In group one (50 patients) bupivacaine of 0. 5% was injected into the skin through a subcutaneous tissue incision. In group 2 (50 patients) injection was performed postoperately. Group 3 (50 patients) received no injection. The pain score of patients was evaluated by the visual analogue scale (VAS) at 6، 12، 24 and 48h after surgery. Time to first analgesia request، total analgesic (pethidine) requirement in the first 48h after operation were recorded. VAS6 score in the injected groups was lower than non-injected group (P<0. 005). Post incisional VAS6 score was lower than preincisional score (P<0. 041). There was no significant differences between other scores in groups. First request to analgesia was 5. 7±3. 9 h in group 1،5. 8±3. 5 h in group 2 and 2. 6±1. 02 in group 3 (P<0. 001). Total requirement of analgesic (pethidine) in the first 48 h was 46±23. 69 in group 1. 34± 23 mg in group 2 and 54 ± 22. 7 mg in group 3 (P<0. 001). Pain score at 6h (VAS6) in the group 2 was significantly lower than the control group (5. 1±0/83 vs. 4/3 ±1/7; P<0. 005). Subcutaneous injection of bupivacaine 0. 5% (especially post operative) can be an effective method on post operative pain reduction، reduction of Pethidine consumption in the first 48 hour of operation and in increasing the time of the first analgesic requirement.

Introduction & Traumatic asphyxia is a commonly used designation of a rare syndrome related to severe compressive trauma to the thorax. In this study we report ten cases of this syndrome. In evaluation ten patients were seen exhibiting the stigmata of traumatic asphyxia. Data consisting of sex, age, mechanism of injury, clinical finding, associated injuries, length of hospitalization and outcome were studied. There were 8 male and 2 female patients ranging in age from 4 to 56 years. Mechanism of injury was crush due to earthquake in one patient, entrapment beneath a vehicle in one, entrapment beneath a heavy stone in one, crushing with heavy objects in two and car accidents in five victims. Subconjunctival hemorrhage, craniofacial edema and petechiae developed in all patients. Most of the patients suffered some associated injuries including 2 liver injuries, 2 rib fractures, 2 diaphragmatic injuries and one diastasis of pubis. Length of hospitalization ranged from4 to 27 days. There was no mortality. Traumatic asphyxia is a rare but important syndrome after thoracoabdominal blunt trauma that should be kept in mind for early diagnosis and management. It can be associated with other organs injuries.

Diaphragmatic hernias are relatively common after blunt and penetrating trauma. The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) due to coexisting problems and the silent nature of these injuries at the time of first admission are the common causes of morbidity and mortality. Medical records of 34 patients treated for post traumatic diaphragmatic hernias between August 2003 and June 2007 in Al-Zahra Hospital, were studied and data including age, sex, kind and site of trauma, timing and accompanying injuries were recorded and analyzed retrospectively. There were 28 (82.4 %) men and 6 (17.6 %) women, with age range of 1 to 68 years and mean of 32.2±9.1. Rupture of diaphragm was left-sided in 22 (64.7%) and right-sided in 11 (32.4%) and both in 1 (2.9%). Blunt trauma accounted for 22 (64.7%) of patients. Elective operation was done in 7 (20.6%) cases. Diagnosis was established preoperatively in 15 patients (44.1%), and intraoperatively in 13 (38.2 %). The diagnosis was missed in 6 (17.7 %) patients in first operation. Strangulation of viscera was found in four patients. The longest interval between trauma and diagnosis was about 3 years in one case. Mean duration of hospital stay was 12.3 days. Multiple associated injuries were observed in 22 patients (66.7 %). Postoperative complications were encountered in 9 (26.5 %) patients, and the overall mortality was 14.7 %. Diaphragmatic hernia should be suspected in all kinds of trauma to thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedures.

The aim of this study is evaluation of the relation between Systemic Inflammatory Response Syndrome (SIRS) score and mortality and length of hospital stay in trauma patients. Seventy-three trauma patients admitted to Al- Zahra hospital in Isfahan medical university were enrolled to this study. The injury severity score and SIRS of each patient were calculated. In all patients, length of hospital stay, age, sex, trauma mechanism, and vital signs were recorded and blood samples obtained. Patients were followed until their discharge or death. Logistic regression test was used for statistical analysis. Forty three percent of 73 patients had positive SIRS markers. Mean age of patients was 25. 09±14. 35 years. Trauma mechanism was blunt in 84% of patients. Mean of Injury severity and SIRS were 12. 09±10. 15 and 1. 3±0. 07 respectively. Mean length of hospital stay was 5. 6±5. 2 days. There is a significant correlation between SIRS and length of hospital stay (p= 0. 03), and SIR S and death (P=0. 01). WBC count has a significant correlation with length of stay (p= 0. 04) and mortality (p =0. 02). Our findings suggest that admission SIRS score of trauma patients may be used as a predictor of outcome.