Tehran University Medical Journal

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This is a mortality study in internal medicine wards of Amir-Alam Hospital, since the beginning of 1374 to end of 1376. Here, we reviewed, prevalence of disease lead to death, the ward and invasive interventions and duration of admission of patients before death. In this study, records of 85 patients were reviewed. 68.2% of patients were men and 31.8% women. Mean of age was 61.6% with minimum of 18 and maximum 95 years. The most prevalent diseases leading to death were cardio vascular (41.2%), cancer 29.4%, GI tract diseases (10.6%), pulmonary diseases (8.3%), CNS (7.1%), hemathologic (4.7%), DM (3.5%). Mean duration of stay in hospital before death was 6.6 days (max 30-min 1). This figure in different wards were: ward 1 (7 days), ward 2 (11 days), ward 3 (5.9 days) ICU (5 days) and CCU (4.7 days). 90.5% of patients died due to their diagnosed illnesses. Invasive tests and intervations were performed in 40% of them. As a whole 35 patient were died in CCU. This research and others like it showes the failures of our patient management system and can guide us in approaching to better medical care.

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This article is to verify mortality rate, cause of death, severity of injury (ISS),GCS, patient fate in hospital, pattern of specific organ injuries and some other characteristics among injured pedestrians and car occupants referred to three trauma centers in Tehran (Sina hospital, Shohada Tajrich hospital, Fayazbakhsh hospital) from May 1996 until May 1997.
Materials and Methods: 57367 patients were admitted to emergency department of these centers among which, 6027 victims of motor-vehicle accidents were included in this study.
Results: 71% of cases were pedestrians and rest was car occupants. M/F ratio was 1.8/5. Mean age was 29y. Motor vehicle accidents occurred most commonly during nights. The patients' GCS at arrival in emergency department had similar distribution in both groups. The most commonly injured organs in both groups were: integument, head and neck, extremities and bony pelvis. Thoracic and spinal injuries were more common among car occupants. Extremities and boney pelvis injuries were more common among pedestrians. The mortality rate was the same between both groups. Mortality rate was affected by GCS at arrival and severity of injury. Mortality rate among the old was 4 times the rate among the children. The accidents most commonly occurred on metropolitan roads and streets. The most common cause of death between both groups was head injury. Surprisingly head injury was a more common cause of death among the car occupants.
Conclusion: Pattern of specific organ injuries was different form the pattern in previous studies as the pattern was virtually the same between both groups except for spinal and thoracic injuries were more common among the car occupants.

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Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women) with a mean age of 50 years (range: 19-83 years) in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.
Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%). The most frequent late-onset medical and mechanical complications were peritonitis (6.3%) and hernia (3.7%). During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.
Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.

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Background: Dopaminergic is the most important neurotransmitter is fear. The dopaminergic mesolimbic pathway has essential role in excitable behavior, and it's role in Parkinson disease. The aim of this research in study, the effect of dopaminergic pathway in fear response.
Methods: The elevated plus maze was used in combination with the percentage of time spent in the open arms of the maze (OAT%) and the percentage of entries into the open arms (OAE%) to measure fear. Increases in the OAT% and OAE% indicate an anxiolytic effect (reduction in anxiety), whereas decreases in the OAE% and OAT% indicate an anxiogenic effect. After five days, the rats were injected with saline and different doses of sulpiride and Bromocriptine.
Results: Results showed that intracerebroventricular administration of sulpiride, in the doses of 5, 20μg/rat and bromocriptine, D2 agonist in doses 65, 95μg/rat produced a significant effect comparing to sham groups (p<0.05). While intracerebroventricular administration of sulpiride 15, 10μg/rat, and bromocriptine 70, 80μg/rat, did not show any significant effect comparing with sham group (p<0.05). In the current research intracerebroventricular administration of sulpiride, D2 antagonist at the doses of 5, 10, 15, 20μg/rat and Bromocriptine, D2 agonist in the doses of 65, 70, 80, 95μg/rat were used and theire effect on the fear behavior were studied.
Conclusions: The possible effect of Dopaminergic system in the fear process, especially D2 receptor increase fear.

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