morteza khavaninzadeh

Intestinal duplication is a rare congenital disorder that can occur anywhere in the gastrointestinal tract. The pathophysiology of duplications remains unclear, and various theories have been proposed. This report presents a case of a young man who came to the clinic with constipation and obstructive defecatory syndrome. Preoperative colonoscopy and imaging revealed no abnormalities in the colon. During the operation, a large colon mass was found and resected, and a primary colocolic anastomosis was performed laparoscopically. After specimen extraction, the colon was cut to assess the etiology. A congenital duplicated lumen of the sigmoid was found, with an accumulation of fecal material in the second lumen causing pressure and obstructing the main lumen. Duplications are a rare cause of intestinal obstruction and should be considered in the differential diagnosis of chronic or partial obstruction. This appears to be the first reported case of laparoscopic resection of sigmoid duplication in an adult man with chronic constipation in the literature.

Identification and control of clinical predictors of arteriovenous (AVF) failure can improve the long-term outcome of hemodialysis patients. The effects of these factors on the outcome of AVF are not still clear. So, we aimed this study to compare the effect of hypertension and diabetes on early failure of AVF.  

In this retrospective study, we evaluated 400 patients with ESRD referred to our clinic for the creation of the first AVF from July 14, 2001, through August 7, 2018. One month after AVF creation, the patients were referred to the clinic for patency control. Demographic characteristics, previous history of diabetes and hypertension, and laboratory data of all patients were recorded preoperatively. Data were entered to SPSS v.24 and Study data were analyzed with chi-square and independent student t-test. Then, early failure of AVF and its relationship with a history of diabetes and hypertension were assessed.   

There was no statistically significant relationship between the history of diabetes and early AVF failure risk in ESRD patients (OR, 0.78; 95% CI, 0.25 to 2.43). Furthermore, the history of hypertension was significantly lower in the early failure of AVF group (OR, -2.82; 95% CI, -1.42 to  -5.59). Although, this effect faded when using regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36). There was a higher Body mass index in the non-early failure group (p = 0.041). There was no significant difference in age (p = 0.512), gender (p = 0.091), history of smoking (p = 0.605), treatment with insulin (p = 0.683), oral antidiabetic agents (p = 0.734), duration of diabetes (p = 0.384), and duration of hypertension (p = 0.093).  

We reported that the history of diabetes was not higher in the early failure group, while there was a lower risk of AVF failure in patients with a previous history of hypertension.

Autogenous arteriovenous fistulas (AVFs) are the recommended type of vascular access for hemodialysis (HD). Nonetheless, the precise outcome of Proximal Radial Artery Arteriovenous (PRAAVF), as well as its risk of failure and complication, has yet to be determined.

In the current single-center, by retrospective analysis of prospectively collected data, we compared the outcome of Brachial Artery AVF (BAAVF) and Proximal Radial Artery Arteriovenous (PRAAVF) in end-stage renal disease (ESRD) patients who were referred to our center between 2010 to 2018. The outcome of the fistula was routinely assessed for all patients at least two years after the surgery. All data were analyzed in SPSS software (version 16). The success rate for each procedure was reported as a percentage. The Chi-square test was used to compare the success rate between the groups.

A total of 146 patients (86 males, and 60 females) with a mean age of 55.79±17.03 years were included in the study. The results demonstrated that men and women did not significantly differ in the success rate of PRAAVF (P=0.076). The PRAAVF showed a significantly higher success rate in the 30-39 age range (P=0.03). The success rate of BCAVF did not display a significant difference between different age and gender groups (P> 0.05 for both). The success rate of PRAAVF was lower in both diabetic patients and smokers, as compared to that in healthy individuals (P=0.032 and P=0.001, respectively). None of the patients who underwent PRAAVF implementation had steal syndrome (as compared to the 2.8% rate of steal syndrome following BAAVF implementation)

As evidenced by the obtained results, PRAAVFs, which are associated with a very low risk of ischemic steal syndrome, can be regarded as safe and suitable vascular access. Accordingly, when it is anatomically feasible, PRAAVFs should be preferred over BAAVFs due to their superior clinical outcomes.

The standard surgical treatment for low rectal cancer is abdominoperineal resection (APR). Comparing to primary closure, immediate flap reconstruction has shown to have good outcomes. We aimed to assess the inferior rectus abdominis muscle flap complications after APR surgery, a new method of reconstruction.

This study was conducted from 2014 to 2016 in a single center in Firoozgar Hospital, Tehran, Iran. Eighteen patients who underwent pelvic floor closure with inferior part of abdominis rectus musculofascial flap were included enrolled. The sampling method used in this study was census. All patients had distal rectoanal malignancies. A checklist including age, gender, tumor location, complications after surgery, tumor type, length of hospital stay, length of operation, neoadjuvant chemotherapy and neoadjuvant radiotherapy history was filled for all patients.

Among 18 participants, 27.8% were female. The mean age of participants was 58.28 ± 17.86 yr (minimum of 19 and the maximum of 89 yr). The pathology of the tumor in all but one of the cases was adenocarcinoma (94.4%). The overall complication rate after surgery was 27.8%. In total, 80% received neoadjuvant chemoradiotherapy. In a one year follow-up, 16.8% of patients died.

Inferior part of rectus abdominis muscle flap was a reliable and comparable means of reconstruction after APR surgery with low rate of complications and mortality.

The survival of arteriovenous fistula (AVF) remains an important problem for hemodialysis patients, accounting for 20% of all hospitalizations related to AV access problems in western countries. We designed an observational prospective cohort study on 265 AVFs and evaluated their results after 4 months of fistula creation and its relation to laboratory tests as ESR and CRP levels.

Wrist or antecubital AVFs  were created for patients with End-Stage renal disease. All laboratory tests (ESR and CRP) were checked quantitatively. The patients were followed-upfor at least 4 months and failure or maturation of AVFs were recorded in a checklist.

177 (66.8%) males and 88 (33.2%) females were included. The surgeon created 161(60.8%) wrist and 98 (37%) antecubital AVFs. The mean age of patients was 53.18±17.1, ranged from 8 to 91 years old. CRP and total protein had significant differences between the two groups of failure and mature accesses (0.029 and 0.045 respectively).

  High CRP level is recognized as a reliable predictor for the survival of AVF.

Stroke is the leading cause of death in patients with kidney failure. Chronic kidney disease (CKD) is strongly associated with stroke with various purported mechanisms proposed and End-stage renal disease (ESRD) patients are in a condition where both kidneys are impaired and require kidney transplantation or dialysis, and unfortunately, the number of patients with ESRD has grown rapidly during the last several decades. Several conventional risk factors for atherosclerosis are more prevalent in patients with CKD and the risk of stroke is 5–30 times higher in patients with CKD. Especially, Diabetic kidney disease (DKD) is the leading cause of ESRD and a significant risk factor for progressive macro- and microvascular disease. The risk of hemorrhagic stroke (HS) has been reported to be higher than ischemic stroke (IS) in hemodialysis (HD) patients. Moreover, for doing HD, creating a connection point in the patient‘s body is necessary; this connection point is creating in a vascular access (VA) surgery and there are three usual methods for a VA: Arterivenous Fistula (AVF), Arterivenous Graft (AVG) and central venous catheter (CVC). In these three mentioned VA methods, if the status of patient be urgent, creating CVC is a common approach for providing patient to a fast HD and continuing his or her life, such that implantation of a CVC is one of the most common surgeries for VA as a requirement for HD. In United States (US), the prevalence of recognized CKD has steadily risen year after year across all stages of CKD. From 2016 to 2017, the proportion of recognized CKD patients increased from13.8% to 14.5%. Among those without a CKD diagnosis but with both diabetes mellitus and hypertension, 43.2% had urine albumin testing in 2017, and a large majority (80%) of HD patients started dialysis using an indwelling catheter. The standardized US rates for ESRD (ie, dialysis or transplantation) rank among the highest in the world. The prevalence of ESRD continues to rise and reached 746,557 cases in 2017 (vs 727,912 in 2016), representing a 2.6% increase since 2016, The published annual data report also highlights key findings regarding ESRD among children, adolescents, and young adults. From other hand, although there are various paths for inserting CVC, such as subclavian, jugular and femoral, but the important problem is that, there are some reports about high risk of stroke is both in CKD patients and far higher in patients with CVC implanted for HD! Given the risk of death after stroke and the problems it poses to the individual, others, and the community, it is important to evaluate the risk in patients with underlying conditions. Indeed, with greatly increased risk of stroke and poorer outcomes, in this vulnerable group of patients, it is important that preventive strategies be better applied to reduce stroke rates. Thereby, this article is a review of stroke in patients with DKD and approach to managing it.

In the present study, we analyzed totally data of 1566 patients, which included two datasets: at first, there are 1098 stroke patients from US and secondly, there are 468 Iranian HD patients, who have used CVC as a VA method for HD possibility. The first dataset is shared by the US researchers for completing their previous studies and second dataset gathered after designing a check list from the Hospital Information System (HIS), based on saved files of the under HD patients who accept by the study on their treatment data. The stroke populations were referred over two years and HD populations to US hospitals were referred over a five-year to Hasheminejad Kidney Hospital. For data analysis, we calculated correlation coefficients by SPSS software. Moreover, for targeting extract novel, useful and hidden patterns from the data, we executed data mining algorithms in both Rapid Miner Studio and SPSS tools. Indeed, with the help of data mining techniques, more details of association rules into the patient characteristics will be revealed. Therefore, we designed descriptive approaches of data mining, which were included: (a) Decision Tree Operator for data classification (by accuracy rate = 81.51%) which implemented in Rapid Miner Studio and (b) CHAID algorithm which executed in SPSS software (by accuracy rate of classification= 98.75%). These accuracy rates explain an acceptable result in their related decision trees which gives us the motivation to interpret them as a scientific idea and adapt to medical realities.

In the first data set, 891 patients had IS and 207 patients had HS; in these patients, where 388 patients had kidney problems and 64 patients had chronic kidney disease. Studies showed that there was a significant relationship between chronic kidney disease and ischemic stroke (Pearson correlation with p<0.001). The second data set consists 468 hemodialysis patients, including 324 females and 144 males, of which 368 patients had a permanent catheter and 100 had a non-cuffed catheter. By interpreting the exported decision tree, these results were evident: (a) the history of kidney diseases has an unmissable role in trouble patients to the stroke! This is because that the kidney variable was placed in the root of the extracted decision tree. (b) after history of kidney diseases, the second-high risk role in the case of stroke, was dedicated to history of heart diseases; (c) in both of recent results, the dominant type of stroke is related to IS. (d)

This study showed that the risk of stroke in patients who used catheters before venous arterial fistula was 84.21% and while there was no significant relationship between the age of dialysis patients and their stroke, but in addition to catheter implantation, they had a history of hypertension or diabetes were also at risk for stroke. Finally, we discuss a paradox with reference to what we presented at the WoCoVA 2020 Conference and suggest that for future research on the relationship between the various methods of VA - which are essential for hemodialysis and patient life - with stroke and investigate the increased risk of death.

Population aging has brought a rise in the prevalence of diabetes and hypertension, leading to more cases of renal failure. Hemodialysis, as a method of renal replacement therapy, by far prevails over peritoneal dialysis (93.5% vs. 6.5%). Although arteriovenous fistula (AVF) is frequently chosen as the vascular access route for chronic hemodialysis; it has limitations including non-maturation. As maintenance of an AVF is much more costly than its creation, foreseeing maturation failure can lead to a wiser allocation of patients to AVF surgery or other alternatives, with potential for significant cost containment. Previous studies have some challenges: they used intraoperative and postoperative parameters (AVF blood flow, diameter, and depth) or parameters that are costly to collect (morphologic and functional vessels characteristics), and they used statistical analysis that puts restrictions on data. In this study, we aim to provide a data mining framework for predicting AVF non-maturation using routinely available preoperative parameters, such as serum metabolic values and inflammatory markers.

We investigated the relationship of routinely available systemic inflammatory markers and baseline metabolic values in 114 end-stage renal disease patients (over 35 years of age undergoing their first radio-cephalic AVF access surgery at wrist level for chronic hemodialysis). In this study, for the first time to our knowledge, we applied predictive analytic tools such as Random Forest for retrospective analysis of prospectively collected data between 2011 and 2018.

Our results showed that a combination of inflammatory markers and serum metabolic values can prognosticate AVF maturation outcomes with an accuracy of 0.723, by the 95% confidence interval of (0.715, 0.731) and AUC of 0.853. Also, a combination of inflammatory markers, including albumin, c-reactive protein, erythrocyte sedimentation rate, hemoglobin, lymphocytes, neutrophils, white blood cells, platelets, and red blood cell distribution width, can prognosticate AVF maturation outcomes with an accuracy of 0.674, by the 0.95 confidence interval of (0.665, 0.684) and AUC of 0.824.

Risk stratification of patients for AVF non-maturation before attempting the first AVF surgery may help prevent multiple surgical failures and costly endovascular interventions by allowing vascular surgeons to make an individualized choice of vascular access method for new patients.

The present study aimed at investigating the necessity of preoperative liver function tests (LFTs) in patients with uncomplicated gallstone disease before laparoscopic cholecystectomy.

Significant relationship between common bile duct (CBD) stones and acute cholecystitis is reported. There are contradictory reports about the effect of CBD stones on liver function tests in patients (LFTs).

In the current study, patients with symptomatic cholelithiasis who referred to hospitals during January 2015 and May 2016 were enrolled. Routine tests and ultrasonography were performed on all patients before surgery. Data were presented as means ± SD and qualitative variables as frequency (percentage) were considered. Statistical analyzes were performed with SPSS software.

A consecutive series of 270 patients (58 males and 212 females) who referred for laparoscopic cholecystectomy were enrolled in this retrospective study. Pre- operative LFTs were normal in 249 patients (85%) and abnormal LFT was detected in 41 patients (15 %).

This study showed that 15 % of patients with cholelithiasis without dilated CBD had impaired LFTs.  Routine LFTs in preoperative evaluation of symptomatic cholelithiasis usually reveals normal findings and is not helpful in uncomplicated cholelithiasis.

Hemodialysis is the sole way for management of patients with End Stage Renal Disorders (ESRD). Nowadays, inserting arteriovenous fistula is one of the most common methods for effective hemodialysis. Several factors have been reported for failure of arteriovenous fistulas such as diabetes, biochemical factors, low hemoglobin and increased level of blood calcium and phosphorus. Decision tree regression modeling is more useful among clinical studies. Tree regression modeling was used for present study for assessment of causes of failure in arteriovenous fistula among hemodialysis patients who referred to Hasheminejad Kidney Center. The material of this historical Cohort study was gathered from records of hemodialysis patients with active and failed arteriovenous fistulas. Bivariate analysis and logistic regression analysis was performed and tree regression model created. There is significant association between arteriovenous fistula success and diabetes, hypertension among hemodialysis patients (p<0.001). Although we found significant association between serum level of hemoglobin and arteriovenous fistula outcome in bivariate analysis, but regression analysis showed only age, diabetes and hypertension could be looked upon as independent predictors of arteriovenous fistula success. Hypertension and diabetes mellitus have significant roles in the outcome of AVF failure. Regarding the effect of “age” variable, we recommend further studies about AVF maturation, based on different age groups of hemodialysis patientsthe learning environment in order to increase students' motivation and they can achieve the success.

The kidneys of patients with chronic kidney disease (CKD) do not function well enough and those in end-stage renal disease (ESRD) of CKD need hemodialysis (HD) as a common renal replacement therapy (RRT) procedure. HD requires a vascular access (VA), and arteriovenous fistula (AVF) is the common VA choice in the world due to its very few complications. Despite the widespread use of AVFs, some risk factors maximize AVF failure, which is accompanied by complications of the patient such as repeating VA surgeries and hospitalization. Therefore, finding effective factors in the success of surgery is highly important and, thus, this study aimed at measuring the effect of anastomosis angle on the success of AVF surgery. This study evaluated the effect of conducted angle in an AVF anastomosis on AVF maturation. The images of 48 created AVFs for CKD patients was provided over a one-year period (from May 2016 to April 2017). Cross-tab analysis was used, and significance level was considered meaningful at p-value≤0.001. A centralized database was designed to integrate data. A method for image processing was developed and geometrical characteristics of the vessels (such as anastomosis angle) and also the diameter of artery and vein were measured via AutoCAD 2017 software and exported to the database along with other data. The rate of the AVF failure in the studied patients was 8.96%. The anastomosis angle ≤ 30° is preferable from the AVF status point of view because most AVF maturation (or least AVF failure) rates are detected at this range. This study was performed based on a new approach without the need to measure hemodynamic parameters. Moreover, it signified the important role of anastomosis angle in the function of AVF, showing that the anastomosis angle ≤ 30° is a preferable intraoperative recommendation for AVF surgery

Arteriovenous fistula is an important method for hemodialysis and prediction of fistula function and failure rate and access is crucial. This study was performed to determine the association between Doppler ultrasonography findings with function and failure and access rate of fistula.
In this observational comparative cross-sectional study, out of 108 patients requiring fistula who had no appropriate condition, 61 consecutive patients with chronic renal failure under hemodialysis were enrolled and Doppler ultrasonography findings were determined and the association with failure and access rate was assessed.
In this study, thrill was present in 96.7%. The outcome was good in 92.2%. There was no association between Doppler ultrasonography findings with function and failure and access rate of fistula (p> 0.05).
Finally, according to the obtained results, it may be concluded that Doppler ultrasonography is useful to improve the function, reduce the failure and increase the access rate of fistula.

Central venous catheters (CVCs) are increasingly used for central vein pressure measurement, fluid replacement, blood-product transfusion, hemodialysis, and chemotherapy. Considering the urgent nature of placing CVCs in many patients, local anesthesia is used in order to facilitate recovery and prevent the side effects of general anesthesia. The successful placement of CVCs can reduce injury to adjacent structures.

This study aimed to assess the patients’ pain level, satisfaction, and injury to adjacent structures. Patients and

This case series evaluated 213 patients with end-stage renal disease (ESRD) who had been referred for duallumen hemodialysis catheter (large-bore) placement during the year 2011 at Hasheminejad kidney center (Tehran, Iran). Catheters were placed by a single surgeon, and 5 ml of subcutaneous lidocaine 2% was used at the site of catheterization. At the end of the procedure, pain was measured using a visual analog scale, and the patients’ satisfaction was verbally determined with regard to whether they would accept local anesthesia if they required catheter placement again in the future.

Fifteen patients reported that they would prefer general anesthesia for a similar procedure in the future. Five of these patients experienced mild pain with the present procedure, and the remainder had severe pain. The mean pain scores were 1.93 ± 0.799 in patients who preferred general anesthesia and 1.26 ± 0.450 in the remainder. The difference between the two groups was significant. One hundred ninety-eight patients experiencedmild pain during catheter placement, of which 187 (94.4%) would accept local anesthesia for this procedure in the future. Twenty-two (10.3%) patients underwent arterial puncture, 163 had single-attempt venous puncture, and 50 had two or more puncture attempts. In nine patients, the puncture was unsuccessful and the vein could not be found despite three attempts to insert the needle; for these patients, the anatomical area approached for access was changed.

Local anesthesia facilitates quick recovery, is time-saving, and can reduce hospital expenses. It seems to be a suitable method for reducing complications and increasing patient satisfaction.

A growing number of patients with End-Stage Renal Disease (ESRD) are undergoing long-term hemodialysis (HD). HD needs a vascular access (VA) and complications of VA account for a sizable proportion of its costs. One of the important cardiovascular diseases (CVD) is atherosclerosis, which is a major cause of premature deaths in the world. So, it is essential to find the risk factors to treat them before they cause an obvious CVD.

We analyzed data from 174 ESRD patients who were candidate for Arterio Venous Fistula (AVF) creation from April 2008 to March 2009 in Hasheminejad Kidney Center by convenient sampling. X-ray images were used and C 4.5 algorithm of data mining techniques revealed the roles of two risk factors for atherosclerosis of diabetic ESRD patients. Pearson coefficient was also used to measure the correlation between the parameters.

Diabetic patients had significantly more calcified arteries in their forearm X-ray than other patients (p This study investigates the role of high plasma levels of TG and phosphorous in the development of atherosclerosis in diabetic HD patients. Although many studies showed that hypertriglyceridemia plays a promoting role in the development of CVD, our study also found an inverse effect of plasma levels of TG on the atherosclerotic involvement of radial and ulnar arteries in diabetic patients, and therefore our results support this suspicion that hypertriglyceridemia plays a significant role in developing atherosclerosis.

Central Venous Catheters (CVCs) are used not only as a tool to access to central venous system, but also for hemodynamic monitoring, parenteral nutrition, chemotherapy and hemodialysis. The use of CVCs is associated with some complications notably infections that are troublesome both to patient and physician. We conducted this study to examine catheter fixation with skin fold technique and to evaluate risk of catheter infection in this method and compare it to conventional technique.
This study is a controlled clinical trial (IRCT: IRCT2015081723229N1) and all cases are patients over 18 years, admitted to Hasheminejad Kidney Center from 2011 to 2012, who needed an internal jugular venous catheter for hemodialysis. Finally, two hundred and twenty two patients entered the study. We used chi square test and logistic regression for data analysis. P-value less than 0.05 was considered significant.
In this study Mean±SD age of patients was 54.50±15.71 years. Mean ±SD ages of patients in the case and control group were 54.56±16.43 and 54.42±14.84 years, respectively. The rate of catheter infection significantly decreased with skin fold technique: Five patients (3%) in case group and 13 patients (16%) in control group had infection (p=0.002).
The findings of this study demonstrated that catheter fixation with skin fold could be an appropriate technique in comparison with current conventional method. However, further studies on other possible and unpredictable complications of this technique is required.

Vascular Access (VA) is an important aspect for blood circulatory in Hemodialysis (HD). Arteriovenous Fistula (AVF) is a suitable procedure to gain VA. Maturation of the AVF is a status of AVF, which can be cannulated for HD. This study aimed to discover the parameters that effectively reduce the duration between VA and start of HD, which symbolizes the maturation time (MT).
Ninety-six patients who underwent AVF creation were selected for this study. The decision tree method was used based on CART/C4.5 algorithm, which is one of the data mining approaches for data classification. Vascular diameter ratio (VDR) coefficient was obtained (VDR=Artery/Vein diameters).
We investigated the relationship between the VDR and MT in this study and found that MT is reversely related to VDR in elderly patients, while this relation was direct in younger patients.
The analysis revealed a Spearman's correlation coefficient for Vein diameter with MT. MT decreases when diameters of vein and artery are close to one another. This study can help the surgeons to identify high- risk patients who elongate MT for HD.

Central Venous Catheters (CVCs) are used not only as an access to central venous system, but also for hemodynamic monitoring, parenteral nutrition, chemotherapy and hemodialysis. The use of central venous catheters is associated with some complications notably infections that are troublesome both to patient and physician. We conducted this study to examine catheter fixation with skin fold technique and evaluated risk of catheter infection in this method and compared it to conventional technique. This study is a controlled clinical trial and cases are all the patients over 18 years, admitted to Hashemi-Nejhad kidney center from 2011 to 2012, who needed an internal jugular venous catheter for hemodialysis. Two hundred and twenty two patients entered the study. Patients were randomly divided to skin fold suturing (127 patients) and standard suturing (95 patients) groups. Chi – square test and logistic regression were used for data analysis. P value less than 0.05 was considered to be significant. The mean age of patients in skin fold suturing and standard suturing groups were 54.5±16.43 and 54.4±14.84 years, respectively. The rate of catheter infection significantly decreased (mean difference=13%) with skin fold technique (3%) in comparison to standard suturing group (p=0.002). The findings of this survey demonstrated that catheter fixation with skin fold could be an appropriate technique in comparison with current conventional method. However, further studies on other possible and unpredictable complications of this technique is required.

Arteriovenous Fistula (AVF) is the ideal method of vascular access for patients on maintenance hemodialysis (HD). Therefore it is an important part of treatment in HD. There are several observations that indicate the role of inflammation in failure of AVF. The aim of this study was to evaluate the hematologic and inflammatory biomarkers in early AVF failure. This case-control study included 110 ESRD patients, whom were undergone AVF creation, divided in two groups. About 700 radius-cephalic AVF were created during these two years. We found 55 cases with AVF failure. In this study, we compared those 55 failures with 5 functional AVF which were selected using randomized sampling from the rest of patients according to age, gender, and AVF location. Levels of serum C-reactive protein (CRP) were checked in both groups to evaluate the relation between AVF failure and CRP level before surgery. The mean±SD age of the patients was 49.7±17.28 years. CRP was positive in 34 patients (61.8%) with unsuccessful fistula function, while only 4 (7.3%) of those with successful AVF had positive CRP and the rest had negative CRP. The difference between the two groups of patients was strongly significant (p<0.001). Statistically, there was not any significant difference between the average of age (p: 0.580) of patients in the control and experimental groups. However, the gender (p: 0.832) discrepancies was not meaningful between the groups. AVF thrombosis is one of the main complications after AVF creation. Therefore, it is recommended to check CRP before AVF surgery to prevent possible failure of the fistula function.

Chronic Kidney Disease (CKD) is a complicated kidney problem causing permanent renal failure in progressive stages. The final stage of CKD is called ESRD in which most accepted management is Hemodialysis (HD). Arterio-Venus Fistula (AVF) is the most practical way of making proper access to the blood circulatory system; however, maturation of the AVF is a challenge, since there are number of variables interfering with the whole process. The purpose of this study was to evaluate potentially modifiable factors associated with Maturation Time (MT) after creation of a Vascular Access (VA). In this cross-sectional study, a total of 87 patients referred to the Hasheminejad Kidney Center for AVF creation in 2010 were evaluated. Patients were evaluated before and after the AVF creation and risk factors such as history of blood pressure abnormalities, diabetes and congestive heart failure, as well as the successive development of AVF was studied and finally processed using ‘data mining’ technology. The “Decision Trees” indicated the significant impact of the systolic blood pressure (SBP) in the delay of the patient’s AVF maturation. Also, prediction of AVF maturation was made with 70.59% of precision in regard to their BP condition. This study demonstrated that monitoring the SBP is one of the important steps in management of the cardiovascular variables producing any delay in the process of the patient’s HD. Also the data mining method can discover the hidden relationship between the patient’s medical conditions in order to predict the potential disorders.

Arteriovenous fistula is a popular vascular access method for surgical treatmentof hemodialysis patients. The method, however, is associated with a high rate of early failure varying in the rangeof 20-60%. Predicting early Arteriovenous fistula failure and its risk factors can help reduce its incidence, its hospitalizationrate, and associated costs. In this study, we examined performance of data mining in the predictionof early AVF failure and identification of its risk factors. The data of 193 patients who underwent homodialysis in Hasheminejad Kidney Center were explored. Eightcommon attributes of the patients including age, sex, hypertension level, Diabetes Mellitus state, hemoglobin level,smoking behavior, location of Arteriovenous fistula, and thrombosis state were used in the machine learning process.Two learning operators including W-Simple Cart and WJ48 tree were used in data mining process. Smoking was identified as a factor influencing the relationship between the outcome of vascular accesssurgery and hemoglobin level. Prediction accuracy varied within the range of 69.15-85.11%. According to our results smoking is a crucial risk factor for early Arteriovenous fistula failure, evenat normal levels of hemoglobin. Our results provide further supports for the notion that data mining can helpmedical decision-making process by deciphering the complex interactions between various biological variablesand translating the hidden patterns in data into detailed decision-making criteria.

With the innovative idea of Central Vein Catheter at the end of 80’s، treatment of hemodialysis patients faced a significant change. Nowadays CVC’s are widely used and as a result CVC related complications have become important for surgeons. In this study survival and complications associated with CVC’s have been studied in End Stage Renal Disease (ESRD) patients referring to Shahid Hasheminejad Hospital during 2010-11. In this cross- sectional and descriptive study، all documents of ESRD patients’ that had catheter insertion at Hasheminejad Kidney Center during 2010-11 were included and demographic data، catheter related side effects، site of catheter، and duration of catheter utilization were taken from the records and major catheter related complications، reasons of catheter removal were obtained by descriptive analyses. We also calculated survival of catheters by Kaplan-meyer analytic method. In this study 150 records were enrolled with 122 male and 28 female patients، and a mean age of 56±15 years (range of 19-87 yrs). Regression analyses had shown that increasing age (p=0. 003، RR=0. 78)، Hb (anemia)، (p=0. 04، RR=0. 34)، increased BUN (p=0. 014، RR=0. 37) and Cr (p=0. 023، RR=0. 45) levels had significant correlation with the side-effects. One and two months catheter survival were 88% and 69%، respectively. Side effects were not higher than similar western studies. Studied patients had higher rates of anemia. Catheter thrombosis was reported as the second and local infection as the first common side effects. Survival of central vein catheters in Iran was similar to earlier conducted studies.

Misdiagnosis and treatment of Deep Vein Thrombosis (DVT) and Pulmonary Thromboembolism (PTE) usually cause some problems and also lengthen the hospitalization period and treatment costs. Prophylaxis often reduces the risk of DVT and following PTE، therefore in this study we aimed to determine the frequency of using Prophylaxis to prevent DVTs in Rasoul Akram hospital in Tehran، Iran. In this Retrospective descriptive study، 202 participants were chosen from the patients admitted for surgery in the surgery unites and randomly stratified and classified. Information was extracted for these participants، based on variables and the objectives of this study and after that the frequency of using prophylaxis to prevent DVT was calculated by using descriptive analysis tool. Our study consisted of 105 male (%52) and 97 female (%48) patients in which 62 (%30. 7) were from surgery unite، 52 (%25. 7) orthopedic، 36 (%17. 8) Gynecology، 33 (%16. 3) neurosurgery and 19 (%9. 4) urology. 114 (%56. 43) of participants received prophylaxis versus 88 (%43. 56) the patients did not receive prophylaxis. 13 in high risk groups، 10 in the moderate risk group and 91 were in low-risk group. In our study، the correct usage of prophylaxis was in %24. 3 of incidents، which was consistent with previous studies. In older populations who are subject to more risks in treatment، it is very important to employ more precise prophylaxis treatments. In this study only %14 of participants were from high risk group. Regarding the serious need for prophylaxis to prevent DVT in this particular population، the expansion of our studies toward those populations in higher risks is absolutely suggested.

The invention of central venous catheters (CVC) for hemodialysis (HD), brought about a fundamental change in the treatment of patients who needed HD, from the late 1970’s till the present time. Nowadays the use of CVC is a common medical procedure. Increasing use of these methods necessitates clarification of the exact nature of the effects, and potential complications for surgeons.. This study attempts to determine the frequency of CVC; complications, survival rates and outcomes in HD patients, treated at the Hasheminejad Kidney Center, Tehran from January 2010 till June 2011..Patients and In this cross-sectional descriptive study, we collected data (using the census method) from the records of all patients over the age of 18 years, who had been referred, from January 2010 till June 2011, for CVC insertion. Catheter sites, related complications, creatinine (Cr), hemoglobin (Hgb), survival rate of catheters and the patients’ demographic data, were collected and analyzed.. In this study, 150 patients were evaluated, 122 participants (81%) were male and 28 (19%) were female. The patients’ average age was 56.2 ± 5 years (19 to 87 years). Regression analysis between the patients, with and without complications, showed that increasing age (P = 0.003, RR = 0.78), decreases in Hgb (P = 0.04, RR = 0.34) and also increased Cr (P = 0.023, RR = 0.45), and BUN (P = 0.014, RR = 0.37) are significantly correlated with catheter-related complications as independent risk factors. The one month survival rate of temporary catheters was 77.3% and their two-month survival was 60%. The overall rate of complications in the present study was no higher than in other similar studies. Anemia rates, however, were much higher in our patients. Most of the complications involved catheter infections, followed by catheter thrombosis. CVC survival rates in Iran have an acceptable outcome and results of this study were similar to those of past studies.