- Volume:2 Issue: 4, 2014
- تاریخ انتشار: 1393/09/30
- تعداد عناوین: 10
Is Bedside Ultrasound a Reliable Method for Detecting Soft Tissue Foreign Bodies in Upper Extremity Penetrating Trauma Patients?Page 1BackgroundDetection of foreign bodies trapped in the soft tissue is a diagnostic problem in patients with penetrating trauma referring to the emergency department. In spite of increasing advances in imaging modalities, detection of foreign bodies trapped in the subcutaneous tissue is still problematic. Among the methods available for the detection of foreign bodies, radiography is the most accessible modality, but it can only diagnose radiopaque objects. CT scan has some limitations including cost and radiation. MRI is very expensive and is not always available. Ultrasound is an easy, inexpensive and accessible method and has no radiation risk. It also provides simultaneous imaging and is bed side available and effective, especially in detection of radiolucent foreign bodies.ObjectivesSo the new clinical question is that: Is bedside ultrasound a reliable method for detecting soft tissue foreign bodies in upper extremity penetrating trauma patients?
Patients andMethods112 patients with penetrating trauma of volar surface of hand and wrist were enrolled in this study. All patients were clinically suspicious of tendon injury that made them be candidates for diagnostic surgical exploration. Before the surgery, the patients signed a consent form and then a thorough ultrasonography was performed to evaluate the presence of any foreign bodies. The results were then compared with the records of radiography as well as clinical reports of emergency physician and surgeon.ResultsAmong 112 patients under study, foreign body was detected in 21 patients through clinical examination or surgery, out of which 18 (85.71%) cases were detected by ultrasonography; whereas, radiography was able to detect 16 cases (76.19%). False positive results reported one case (1.1%) in ultrasonography and 0 (0%) in radiography.ConclusionsUltrasonography seems to be a safe and cost effective method to evaluate foreign bodies, especially radiolucent objects, in patients with penetrating trauma and suspicious of foreign bodies that may remain undiagnosed in radiography. Availability of bedside ultrasound for emergency physicians is an important issue, since it is not possible to access the radiologist at any time of the day and night. On the other hand, treatment of patients in emergency department is a cost-effective way, as it reduces the number of surgical explorations that are merely diagnostic and it is also time and cost-consuming for therapeutic system.Keywords: Trauma, Upper Extremity, Patients
Page 2IntroductionLeft ventricular Pseudoaneurysm is an interesting clinical entity. The left ventricular (LV) Pseudoaneurysm, in contrast to a true LV aneurysm, contains only pericardial layer and fibrous elements in its wall.Case PresentationWe report a very rare case of a 47-year-old woman presents with an atypical form of LV apical Pseudoaneurysm confirmed by cardiac magnetic resonance imaging (CMRI).ConclusionsDue to the tendency of LV Pseudoaneurysms to rupture, early surgical intervention is recommended.Keywords: Left Ventricle, Aneurysm, Pseudoaneurysm, Magnetic Resonance Imaging
Page 3Context: In this study, it is tried to present a definition and description of health tourism as well as illustrating the essential infrastructures and the impacts of accreditation.
Evidence Acquisition: In this article, the related articles in websites and libraries were inspected and then the relevant ones that had more association with this subject were chosen and their contents were extracted.ResultsImplementation of international accreditation standards has a significant effect on absorbing medical tourism and removes much of the dangers and disadvantages of medical tourism.ConclusionsSince International Accreditation Standards have clearly stated all processes and organizations are required to implement them, obtaining the relevant licenses can ensure health tourist that they have selected the right country and the right hospital to access their desired medical services.Keywords: Accreditation, Hospital, Medical Tourism
Evaluation of Right Ventricular Systolic Function by Echocardiography in Pulmonary Hypertension Associated With Congenital Heart Disease: a Cross Sectional StudyPage 4BackgroundPulmonary arterial hypertension (PAH) is a serious complication of unrepaired congenital left-to-right shunts. The final consequence is right ventricular (RV) systolic dysfunction and reversal of shunt.ObjectivesThe aim of this study was to evaluate the clinical course and paraclinical findings in a group of patients with PAH associated with congenital heart disease (PAH-CHD). We also compared the results obtained by echocardiographic technique used for assessment of RV systolic function (Tricuspid annular plane systolic excursion TAPSE) with parameters obtained by diagnostic cardiac catheterization.
Patients andMethodsDuring a one-year period (2011-2012), all patients with confirmed diagnosis of PAH-CHD in pediatric cardiology ward of a teaching hospital enrolled in the study. They underwent through echocardiographic assessment and cardiac catheterization.ResultsForty-one patients (22 males, 19 females) with mean age of 5.5 ± 5.5 years (4 months to 18 years) entered in the study. Ventricular septal defect (VSD) was the most common (65.8%) underlying CHD. Patients ≤ 10 years old comprised 71, 8% of subjects. The higher level of Tricuspid regurgitation (TR) was correlated with higher mean pressure of pulmonary artery (PAP), and greater resistance ratio (Rp/Rs) (P = 0.001, and P = 0.044 respectively). Indexed TAPSE (TAPSE/body surface area) had a significant reverse correlation with mean PAP (P = 0.015), and Rp/RS (P = 0.002). There was a significant reverse correlation between indexed TAPSE and TR (P = 0.032).ConclusionsTAPSE is an easy echocardiographic measurement and reflected RV systolic function. Indexed TAPSE has good correlation with hemodynamic data obtained by cardiac catheterization. TAPSE index is recommended for evaluation of RV systolic function in pediatric patients with PAH-CHD.Keywords: Congenital Heart Defect, Echocardiography, Pulmonary Hypertension, Right Ventricle, Tricuspid Valve
Page 5BackgroundCar accidents are one of the major causes of death and serious injuries all over the world. Human factors, especially psychological factors play an important role in accident occurrence.ObjectivesThis study was conducted in order to determine the relationship between self-control and car accidents based on demographic factors in Gonabad, in 2011.
Patients andMethodsIn this correlation study, 440 drivers in Gonabad (219 females, 221 males) were selected with non-probability sampling method, using Morgan table. They all fulfilled personal information and Schneider self-control questionnaires (1974). Data were analyzed with SPSS-18 software using t-test, one-way ANOVA, stepwise regression-test and Fishers test.ResultsData showed that 80.9% of drivers suffer from low self-control. There was a strong negative correlation between self-control and car accident (P 0.05). Stepwise regression test showed that gender and self-control are correlated with accident occurrence.ConclusionsConsidering the results of our study, it seems that paying more attention to all factors affecting car accident is a necessity and in order to reduce car accident rate, preparing a long-term plan for self-control education and evaluation should be put in to consideration.Keywords: Accidents, History, Human
Page 6BackgroundExercise echocardiography is a well-validated technique for the diagnosis of coronary artery disease. In addition to the diagnostic role, it also provides useful prognostic information.ObjectivesThe aim of this cross sectional study was to assess the prognosis of patients with negative exercise echocardiographic results over a one-year period follow-up.
Patients andMethodsThe outcomes of 336 patients who had normal exercise echocardiograms were examined. All clinical and exercise echocardiogram parameters were recorded. Patients were followed up for 1 year. End points were defined as cardiac death, non-fatal myocardial infarction, hospital admission for coronary artery disease, and coronary revascularization.ResultsMean age was 54.55 ± 10.34 years. 63.4 % were women. The most frequent risk factor was hypertension. There was no significant statistical difference between men and women regarding the prevalence of systemic hypertension, diabetes mellitus, and history of coronary artery bypass grafting. 5.67% of men and 8.9 % of women had positive exercise tolerance test for ischemia. Hemodynamic parameters, diastolic function, severity of mitral regurgitation, pulmonary artery pressures, peak strain rate were not significantly different between men and women, but rest strain rates were significantly lower in women. Total exercise times and exercise capacity were higher in men. After a 1-year follow-up there was no cardiac events and mortality.ConclusionsPatients with normal exercise echocardiogram results regardless of ischemia or chest pain during the test had excellent outcomes over a one-year follow-up.Keywords: Outcome assessments, Exercise, Echocardiography, Prognosis
Outcome of Percoutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass SurgeryPage 7BackgroundAdvance progression in percutaneous coronary intervention (PCI) technique, particularly with new advanced drug eluted stents (DES) has made it an effective treatment for many cardiac diseases.ObjectivesRedo coronary artery bypass surgery (CABG) has higher risk of mortality rather than first operation. Although the positive impression of percoutaneous coronary intervention (PCI) in such symptomatic patents has not proven yet, but different studies have evaluated the outcome of the symptomatic post CABG patients after performing PCI. In this study we aim to find out if PCI could be helpful in such patients.
Patients andMethodsIn this study, 111 symptomatic patients with pervious history of single coronary artery bypass graft (without concomitant vale surgery) underwent PCI by a single operator between March 2008 and March 2012. Then, they were followed during the following year after PCI and the incidence of death redo CABG, persistent cardiac symptom and rate of hospitalization were recordedResultsThe successful rate of PCI in this study was estimated to be 94.5% (104 of 111). In hospital MACE was 9.6% (three deaths and one myocardial infarction). 67% (73) of patients were male and 33% (33) were female. 79.6% (86) of PCI procedures were done on native coronary arteries and 20.4% (22) on SVG grafts. During one year follow up, we had 7 death in patients with PCI on native vessels (group A) and 1 death in the patients whose PCI was performed on SVG grafts (group B), (P ≥ 0.999). In group A, 27.9% (24) patients were remained symptomatic; while in group B, 18.4% (4) patients were still symptomatic (P = 0.353). Hospitalization because of cardiac syndrome was recorded for 10.5% (9) patients in group A and 9.1% (2) patients of group B (P > 0.955). None of the patients of group B went under redo-CABG during the follow up but 2.3% (2) patients of group A did (P > 0.289). No case of stent restenosis or target vessel revascularization was recorded in either group. The overall rate of death was 7.6% (8 0f 104), persistent cardiac symptoms 27% (28 0f 104), hospitalization for cardiac symptoms 10.5% (11 f 14) and redo CABG 2% (2 of 104).ConclusionsThis study shows that PCI in symptomatic post CABG patients follows by high successful and low complication rate and positive impression on their cardiac symptoms and could reduce the need for redo CABG. It seems that there is no difference that PCI is performing on SVG or native vessel, the intervention itself improves the patients quality of life.Keywords: Percutaneous Coronary Intervention, Mace, Coronary Artery Bypass Surgery
Comparison Between Two Surgical Techniques Acromioclavicular Tension Band Wiring and Coracoclavicular Screw in Acromioclavicular DislocationsPage 8BackgroundAcromioclavicular (AC) joint dislocations are common in young, active patients and frequently treated in clinical practice. There are many surgical treatments for acro-mioclavicular joint dislocation. The goal of this study was comparing the functional and clinical post-operative results between two urgical techniques, acromioclavicular tension band wiring and coracoclavicular screw in acromioclavicular dislocations.
Patients andMethods20 patients with Rockwood dislocation type III and more referred to Kamyab Hospital from February 2012 to November 2013. They were assessed in terms of surgical indications. The patients were divided in to two groups and the authors used tension band wiring and screw fixation procedures for each group. Coracoclavicular ligaments were repaired in both techniques. In 1, 6 and 12- month follow-up periods, we assessed clinically the acromiomclavicular stability, articular range of motion, VAST score and Oxford shoulder score with stress radiography. The results were then analyzed statistically.ResultsMean age of the patients was 34 ± 8.1 years and 80% were male. Totally, 17 patients (85%) were type 3 Rockwood and 3 patients (15%) were type 5. Full stability was obtained in all patients by comparing the stress radiography and the post-operative ones. About 50% of patients had Oxford shoulder score (OSS) 42-48. 13 patients (65%) did not complain of any pain and 25% had moderate VAST score (4-7). 17 patients (85%) had range of motion more than 150-180. Using t-Student test, no significant difference in type of Rockwood, articular stability, range of motion, OSS score and VAST SCORE was seen between the two groups (P > 0.05).ConclusionsBosworth screw and Tension band wiring are both useful procedures in patients with ACJ dislocation, but each should be used in the selected patients with special indications. Both methods had good results during follow-up period. There was not statistically meaningful difference in the articular stability, range of motion, OSS score and VAST SCORE between the two groups (P > 0.05).Keywords: Acromioclavicular, Shoulder, Tension Band Wiring, Screw
Page 9BackgroundMajor spinal deformity can cause many adverse effects on the patients, body and soul leading to pain, decreased ability to do activity in daily living, and also depression.ObjectivesThe present study aims to assess the quality of life among patients undergoing surgical treatment for spinal deformity, using SRS-30 questionnaire.
Patients andMethodsWe retrospectively evaluated 48 young patients (26 females, 22 males) with major spinal deformity underwent definite surgical correction in our orthopedic department from August 2009 to August 2012. The mean age and follow-up period were 16.2 ± 2.8 years and 38.4 ± 8.8 months, respectively. Demographic characteristics were extracted from the medical records and SRS-30 questionnaire fulfilled pre-operatively and at the last follow-up visit. We used statistical package for social sciences (SPSS) version 13.0 for statistical analysis.ResultsFrequency of underlying diseases was congenital scoliosis in 22 (45.8%), idiopathic scoliosis 20 (41.7%), and Scheuermanns kyphosis 6 (12.5%). Pain and function were relatively unchanged while surgery could significantly improve patients self-image, psychology, and satisfaction. Total SRS-30 score was also improved (PConclusionsSurgical treatment of spinal deformity in the young regardless of the type of disease, can lead to significant improvements in health-related quality of life, as shown by self-image, psychology, and satisfaction in SRS-30 domain scores. Demographic data including sex, age, weight, height, and education were not correlated with the outcome.Keywords: Surgery, Satisfaction, Questionnaire
Page 10BackgroundTranscatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to classic aortic valve replacement (cAVR) for selected, high risk patients with severe aortic stenosis.ObjectivesIn our study, we compared preoperative parameters and postoperative outcomes in patients with TAVI and classic aortic valve replacement.
Patients andMethodsFrom March 2011 to December 2013, 18 patients received TAVI and 143 patients underwent cAVR. We compared preoperative Euro SCORE, 30 day mortality, complications after six month and echocardiography findings.ResultsPatients received TAVI were older than patients underwent cAVR (72.7 ± 2.7: 65.3 ± 2.9; PConclusionsHigh risk patients needing AVR are optimal candidates for transcatheter aortic valve implantation. TAVI is a valuable solution for high risk patients needing AVR. Obtained results are comparable to results in transthoracic AVR in standard candidates for aortic valve implantation.Keywords: Aortic Valve Stenosis, Heart Valve Prosthesis Implantation, Mortality