Prophylactic oral calcium supplement has been proposed in patients undergoing thyroidectomy in order to decrease incidence of postoperative hypocalcemia, and the duration of hospital stay. This study aimed to assess the effects of prophylactic oral calcium in patients undergoing total or subtotal thyroidectomy. Forty three patients who were scheduled for total and subtotal thyroidectomy, were randomly allocated to the case (n=23) and control (n=20) groups. Oral calcium carbonate (1 gram q 8 hours) was given to the patients in the case group starting 12 hours before surgery till 7 days post thyroidectomy. Clinical symptoms of hypocalcemia and postoperative calcium levels were compared between the two groups. The mean postoperative calcium level 12 hours after surgery was not statistically different between the two groups (8.9±0.5 vs. 8.5±0.7, p=0.092); while after 24 hours, calcium level was significantly lower in the control group (8.9±0.5 vs. 8.4±0.8, p=0.037). The number of patients who had paresthesia was significantly higher in the control group than case group, at both 12 hours (p=0.02) and 24 hours postoperatively (p=0.04). Duration of hospitalization was significantly lower in the case group compared to the control group (p=0.006). Prophylactic oral calcium supplementation decreases the hypocalcemia related paresthesia after thyroidectomy and shortens duration of hospital stay.

Tracheostomy is a procedure which aims at better managing patients’ airway. It can be done using two standard and percutaneous. The percutaneous method is a favorable choice for critically ill- patients because it is a less invasive procedure. This study compares the short-term complications of these two methods (during 7 days after the procedure). This study was a cross-sectional research performed on 50 ICU patients in need of tracheostomy. The patients were divided into two groups of percutaneous procedure (15 patients) and standard procedure (35 patients). The complications were registered in questionnaires and the data were analyzed using SPSS software (χ² test and t-test). The two groups had no significant difference in age, sex, and vital signs. Average duration of the procedure was 24.4 minutes in the standard procedure (10-45 minutes) and 26.78 minutes (5-70 minutes) in the percutaneous procedure, and there was no significant difference between two groups (P = 0.814). Average bleeding during 7 days after the procedure was 44 cc (10-150 cc) in standard procedure and 24.7 cc (10-50 cc) in the percutaneous procedure, and the difference was significant (P = 0.012). The other variables were not significantly different in two groups. There was no difference in short-term complications between percutaneous and standard tracheostomy method should be selected considering other important factors.

Thyroid nodules are a common clinical finding and differentiating benign ones from malignant ones is a clinical challenge. The aim of this study was to compare the rate of thyroid malignancies in patients with single thyroid nodules (STN) and multi-nodular goiter (MNG). This retrospective study was conducted on 200 patients who underwent surgical thyroidectomy, between 2008 and 2010, in Shariati hospital, affiliated with Tehran University of Medical Sciences. Data analysis performed using SPSS (version 13). Of these, 63 patients (12 male and 51 female) had STN and 137 subjects (28 male and 109 female) were MNG. The mean ± standard deviation of age in patients with STN and MNG were 39.1 ± 7.1 and 42.7 ± 6.2, respectively. The two groups had no significant difference in age or sex. The rate of thyroid malignancies in patients with MNG and STN were 34.4% and 36.5% respectively, showing no significance difference. The study did not show any statistically significant difference between the frequency of malignant and benign nodules in single and multiple thyroid. Therefore, performing accurate pathologic assessment is recommended for all cases of thyroid nodules (MNG or STN).

First step in chronic dialysis is establishing a suitable dialysis access. Arteriovenous fistula (AVF) has been known as the gold standard for hemodialysis; and due to complex interaction of factors that affect the survival time of fistula, we decided to evaluate survival time and affective factors among the dialysis patients. In a historical cohort study, we analyzed 52 patients of the Semnan and Mahdishahr Dialysis Centers. The data recorded by history taking and physical examination. The survival of fistula was 83%, 80%, 67%, and 40% after 1, 3, 5, and 10 years respectively. Our results showed that the survival time of fistula was higher among patients with left-side AVFs. Factors such as age, gender, underlying disease, dialysis session per week, the time that patients started dialysis after installing fistula and fistula infection did not statistical significant affect the survival time. The survival time of AVF among dialysis patients of Semnan and Mahdishahr is satisfying, and installing the fistula in left hand lead to higher survival.

The goals of this study are evaluation the effect of intravenous (IV) granisetron on the duration of sensory and motor block produced by intrathecal hyperbaric bupivacaine and also post-operative nausea and vomiting in patients undergoing outpatient cystoscopy. 62 patients, undergoing cystoscopy received either 3 mg IV granisetron or placebo 15 minutes before the spinal block. Sensory and motor block were assessed after the intrathecal injection of bupivacaine every 2 minutes until the maximum block was achieved and thereafter every 15 minutes until recovery from the sensory and motor block. Demographic data were not statistically different in the study groups. Duration of sensory and motor block were also not statistically different between the study groups (P = 0.060 and P = 0.070 respectively). No patient in either group had vomiting. Seven patients in saline and zero patient in granisetron group had nausea that was statistically significant (P = 0.040). Time to discharge after surgery was 243 ± 21 and 239 ± 24 minutes in granisetron and control group respectively (P = 0.150). Systemic granisetron had no effect on the duration of sensory and motor block produced by spinal anesthesia with hyperbaric bupivacaine.

Chorionic villus sampling (CVS) and amniocentesis are two invasive methods of diagnostic approaches for prenatal diagnosis. The indication, adverse effects and final outcome of these two methods are different. The goal of this study was to compare indication, complications and outcomes of CVS and amniocentesis in pregnant women underwent prenatal screening program. Medical records of 1464 women who underwent CVS, or amniocentesis were reviewed in two tertiary hospitals (imam and women hospitals, affiliated hospitals of Tehran University of Medical Sciences). For 1073 patients amniocentesis was performed while for 391 cases CVS was one. Mean maternal age, gestational age, and age at birth of the neonates were significantly lower in CVS group than the other group. Mean needle time was significantly higher in CVS group. Mean needle time was significantly higher in CVS Group (1.3 vs. 1.5, P < 0.001). The most finding of CVS result was minor Thalassemia while trisomy 21 was the most finding in amniocentesis group. Rupture of membranes was the most side effects in amniocentesis group and intrauterine fetal death was the most complication in CVS group. Indication, results and complications of CVS and amniocentesis are different.

Large vessels injury is a rare but serious complication of percutaneous central venous catheter placement, which can be fatal. Herein a case of right innominate vein perforation during right internal jugular perm- catheter placement - resulted in thoracotomy because of patient’s hemodynamic instability - is reported.