Tehran University Medical Journal

---

Background: Acute abdominal pain is a common complaint in an emergency setting. An immediate and precise diagnosis is necessary for reducing morbidity and mortality. Several studies have reported that CT scan increases diagnostic accuracy for patients with acute abdominal pain. This study was designed to evaluate the sensitivity, specificity and accuracy of spiral CT scan compared to that of abdominal ultrasound and plain radiography. 

Methods: We assessed the data of 91 consecutive patients, including 45 males and 46 females, ranging in age from 8 to 84 years (mean age 52.38 years) presenting to the emergency department of Sina Hospital, Tehran, Iran, with acute non-traumatic abdominal pain during the years 2003-2005. All patients underwent spiral CT scanning in addition, sonography and plain radiography were performed for 66 and 64 of the patients, respectively. The sensitivity, specificity and accuracy were calculated and compared, based on the final diagnosis, which was established with surgical, pathologic, and clinical follow-up. The data was analyzed by SPSS 13.0 software.

Results: Among the 91 patients examined, CT scan was reported to be normal in 15 patients (16.5%). The most common CT findings were aortic aneurysm (12.1%), pancreatitis (9.9%), ovarian cyst (7.7%), intestinal distension (7.7%), and hepatic cyst (7.7%). The overall sensitivity, specificity, and accuracy of unenhanced spiral CT were 92.2%, 92.86%, and 92.3%, respectively, whereas those of plain radiography were 13.2%, 72.7%, and 23.4%, respectively, and ultrasound 73.2%, 90%, and 75.7%, respectively.

Conclusions: This study suggests that plain radiography is an insensitive technique in the evaluation of nontraumatic acute abdominal pain presenting in the emergency department. Unenhanced spiral CT is accurate for adult patients with nontraumatic acute abdominal pain and should be considered as an alternative to radiography as the initial imaging modality.

---

Background: Immediately after Comprehensive Medical Basic Sciences Examination (CMBSE), the secretariat of the Medical Basic Sciences Education Council (MBSEC) proceeds to rank medical universities according to the students’ scores both in individual academic subjects such as biochemistry, English and in all subjects put together. This study believes that the method used in ranking the universities according to the students’ English scores is not a proper method and thus doesn’t provide accurate results.
Methods: Seven of the major and smaller universities were selected. The language scores of all the students admitted to the medical schools of these universities during 3 academic years of 1378 to 1381 (2426 students in all) in both CMBSE and National university Entrance Examination (NUEE) were obtained. The language scores of each students in NUEE and CMBSE were matched.
Results: A significant correlation (max. R=69%, P<0.004 to min. R=27%, P<0.045) was observed between these two grades in all universities studied. Moreover despite the secretariat’s decision to calculate the scores and rank the universities in two separate groups of major and small universities, in some CMBSEs certain smaller universities were ranked in the group of major ones and in some others vice versa.
Conclusions: This has impaired the university ranking in the subject of English language. This study proposes two different ranking methods, that eliminate the present drawback in university ranking according to their student’s English scores.

---

Background: The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body. In clients with a chronic disease, such as end-stage renal disease, functioning status and hematologic indexes are different than among the general population. Electrolyte and hematologic changes may induce many illnesses for such patients. The purpose of this study is to determine the effects of applying the continuous hemodialysis (HD) the blood test results of HD patients.

Methods: This quasi-experimental, before-after study included 38 HD patients from Hamedan, Iran in 2005. Subjects were selected using simple randomized sampling and were assigned to one group for the purpose of this research and investigated over a period of six months. Data collection tools included demographic questionnaire and control check lists. The first phase of the research involved orientation of the control group, which was limited to completion of the questionnaires and control check lists. Immediately after, the same patients became the case group, upon which continuous HD was applied and hemoglobin, hematocrit, blood urea nitrogen (BUN), potassium, sodium, and albumin tests were performed. Statistical analysis of the data employed SPSS (version 13), descriptive statistics, paired t-test and the Friedman test.

Results: In this group, 47.2% of the subjects were male and 52.8% female. Data analysis shows that, using repeated measurement ANOVA test, a significant relationship between application of the continuous HD and improvement in hemoglobin, hematocrit, BUN, potassium, sodium, and albumin levels (p<0.05).

 conclusion: Application of continuous HD causes a significant improvement in the blood test results of HD patients. We recommend that continuous HD be used, whenever appropriate, to resolve the common causes of complications in HD clients, including abnormal levels of electrolytes, especially potassium and phosphorus, as well as BUN and creatinine.

---

Background: Transrectal ultrasonography guided needle biopsy of prostate frequently used for early detection of cancer has faced the pathologists with a major diagnostic challenge. In recent years P504S has been used as a tumor cell marker for definitive diagnosis of prostatic cancer in small biopsy specimens.

Methods: 70 prostate needle biopsies and 6 transurethral resections (TURP) containing atypical foci as well as 40 morphologically unequivocal prostate cancer biopsies, including 8 with foamy features, were stained with P504S.

Results: 36 specimen out of 40 biopsies with unequivocal cancer, showed variable P504S staining (sensitivity, 90%) 2 minute cancer and 2 foamy cancer lacked P504S staining. of 76 cases with atypical foci (70 biopsies, 6 TURP), 18 were diagnosed as high-grade prostatic intraepithelial neoplasia (HGPIN) - 16 of them showing diffuse moderate P504S staining - and 58 had foci of atypical small acinar proliferation. 14 of the latter cases were highly suggestive of cancer, 4 of which lacked P504S staining. In 44 cases with benign atypical foci, 2 out of 14 cases with atypical adenomatous hyperplasia (AAH) and 1 of 2 post-radiation atypias showed focal weak P504S staining with remaining 28 cases being negative.

Conclusions: P504S has slightly lower sensitivity for detection of prostate cancer than that found previously. Heterogeneous expression patterns may explain negativity in some biopsy specimens with minute cancer. In atypical small acinar proliferations, diffuse positive P504S staining in atypical glands strongly supports cancer diagnosis, but negative staining does not exclude it. P504S seems to have low sensitivity for detecting minute and foamy prostate cancers. Most HGPINs show diffuse moderate P504S staining. AAH and benign glands may show focal P504S staining. We recommend using P504S along with morphologic examination and conventional basal cell markers.

---

Background: Although it is not a new disorder, in recent times we have attained a greater understanding of auditory neuropathy (AN). In this type of hearing impairment, cochlear hair cells function but AN victims suffer from disordered neural transmission in the auditory pathway. The auditory neuropathy result profile often occurs as a part of that of the generalized neuropathic disorders, indicated in approximately 30-40% of all reported auditory neuropathy/auditory dyssynchrony (AN/AD) cases, with approximately 80% of patients reporting symptom onset over the age of 15 years. In the present report, the results of audiologic tests (behavioral, physiologic and evoked potentials) on two young patients with generalized neuropathy are discussed.
Case report: Two brothers, 26 and 17 years old, presented with speech perception weakness and movement difficulties that started at 12 years of age and progressed as time passed. In their last examination, there was a moderate to severe flat audiogram in the older patient and mild low tone loss in the younger one. The major difficulty of the patients was severe speech perception impairment that was not compatible with their hearing thresholds. Paresthesia, sural muscle contraction and pain, and balance disorder were the first symptoms of the older brother. Now he can only move with crutches and his finger muscle tonicity has decreased remarkably, with marked fatigue after a short period of walking. Increasing movement difficulties were noted in his last visit. Visual neuropathy had been reported in repeated visual system examinations for the older brother, with similar, albeit less severe, symptoms in the younger brother.
In the present study of these patients, behavioral investigations included pure-tone audiometry and speech discrimination scoring. Physiologic studies consisted Transient Evoked Otoacoustic Emission (TEOAE) and acoustic reflexes. Electrophysiologic auditory tests were also performed to determine Auditory Brainstem Response (ABR), Auditory Middle Latency Response (AMLR) and Auditory Late Response (ALR). The results of these examinations for these two siblings are discussed and compared with the results of other studies.
Conclusion: Distinguishing auditory neuropathy from other speech perception disorders can be performed by conducting audiologic evaluations as a battery of tests. The probability of generalized neuropathy must be considered in patients with auditory neuropathy symptoms.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cyclosporine is one of the main immunosuppressors used for renal transplant recipients, and is given to prevent transplant rejection. Although the drug increases the survival of patients and grafted organs, it has some side effects independent of its effect on the immune system that are usually ignored. In this study, we evaluate the effect of cyclosporine on serum Mg levels and metabolic side effects in renal graft patients.
Methods: In this study, we followed 157 renal transplant recipients (62 females and 95 males) who were being treated with cyclosporine at a private clinic to prevent transplant rejection. The patients were first physically examined and then blood samples were obtained in order to measure levels of cyclosporine, Mg, creatinine, fasting blood sugar, lipids, calcium, phosphorus, and uric acid levels. We then analyzed the data for correlations between serum Mg levels, cyclosporine and other metabolic complications.
Results: The mean levels of Mg and cyclosporine were 196±0.31mg/dl and 371±192 μg/dl, respectively. Hypomagnesemia was detected in 16 patients (10.2%).There was a significant negative correlation (p<0.05) between levels of Mg and cyclosporine levels (r=-0.53), serum creatinine (r=-0.61), plasma LDL (r=-0.3), fasting blood sugar (r=-0.60) and uric acid (r=-0.36), and no correlation (p>0.05) between levels of Mg and calcium (r=0.2), phosphorus (r=-0.01), triglycerides (r=0.06) and HDL (r=-0.08). Mean levels of cyclosporine, creatinine, LDL, fasting blood sugar and uric acid in patients with hypomagnesemia were significantly different from those patients with normal serum Mg levels (p<0.05). There was no significant difference between the two groups with regard to mean total cholesterol, HDL, calcium and phosphorus (p>0.05).
Conclusion: According to the results of this and previous studies, there is a significant correlation between cyclosporine levels and hypomagnesemia as well as other biomedical complications secondary to hypomagnesemia. Therefore, we recommend routine serum Mg determination and greater attention to hypomagnesemic patients to prevent further complications.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The preferred modality of dialysis is a controversial issue in nephrology. In this study we compare some demographic and epidemiological characteristics of hemodialysis and peritoneal dialysis patients in an attempt to analyze this issue.
Methods: The results of the research protocol "A survey of the epidemiological characteristics of chronic dialyzed patients in Khorassan province", was used to compare some demographic and epidemiological aspects of chronic hemodialysis and peritoneal dialysis patients in search of any statistically significant difference.
Results: A total of 836 chronic dialysis patients entered this study, 802 (95.9%) of which were under chronic hemodialysis, and 34 (4.1%) patients were undergoing peritoneal dialysis, with 339 (42.3%) and 12 (35.3%) being female, respectively. The mean age for each group was 47.57 and 46.75 years, respectively. The causes of end-stage renal disease in hemodialzed patients were most commonly hypertension (32.2%), followed by diabetes mellitus (22.3%), unknown causes (19.6%) and chronic glomeru-lonephritis (10.2%). In the peritoneal dialysis group, chronic glomerulonephritis (32.4%) was the most common reason for dialysis, followed by diabetes mellitus (26.5%) and unknown causes (11.8%). The mean serum hemoglobin creatinine, calcium, and phosphorus levels for hemodialysis patients were 10.42, 8.5, 8.93, and 6.03 mg/dL, respectively, and those for peritoneal dialysis patients were 11.28, 8.52, 9.41 and 5.40 mg/dL. There were no statistical differences between the median age, sexual distribution and mean levels of Hgb, Ca, phosphorus, creatinine, HCV antibody and HbsAg of the hemodialysis patients and those of the peritoneal dialysis patients.
Conclusions: The results of our study show that hemodialysis and peritoneal dialysis are similarly effective treatments.

---

Background: There is a growing interest in understanding the biological effects of time-tested folk medicinal plants including the green leafy vegetables, which supply minerals and vitamins to the diet. Trigonella foenum-graecum L (fenugreek) is a dietary vegetable and there are reports concerning its antinociceptive effects in Iranian traditional medicine. Its seeds are also known for their carminative, tonic, antidiabetic, antineoplastic and restorative properties. These reports and the hypoglycemic effect of fenugreek leaf extract encouraged us to assay fenugreek aqueous extract for cytotoxicity on NIH3T3 mouse fibroblast cells.

Methods: The NIH3T3cell line was purchased from National Research Center for Genetic Engineering and Biotechnology of Iran. The cells were plated in 24-well microtiter plates with DMEM+F12 medium containing 10% fetal calf serum supplemented with 445 mg/L L-glutamine and maintained at 37^oC with 5% CO₂/95% air. Following a 24-hr incubation period, various concentrations (0.01-20 mg) of the extract to the culture wells. Cell viability was assessed using trypan blue and MTT assays after five days of incubation.

Results: The results show that the IC₅₀ of the fenugreek extract as calculated from the trypan blue and MTT assays were 1.25 and 2.5 mg/mL, respectively.

Conclusions: Our findings, therefore, suggest that the aqueous extract of fenugreek is classified as nontoxic. This observed cytotoxicity is not specific and could be due to membrane disturbances.

---

Background: Hepatitis C is a major cause of chronic liver disease and hepatocellular carcinoma. Hepatitis C infection also has extrahepatic manifestations, including cryoglobulinemia and lichen planus. Lichen planus is a relatively common mucocutaneous disorder, and, due to its chronic pattern and increased incidence of malignancy, diagnosis and treatment of this disease are very important. The aim of the present study was to investigate the prevalence of oral lichen planus in HCV-infected patients.

Methods: In this cross sectional- descriptive study, the prevalence of oral lichen planus was evaluated by means of observation, clinical examination, questionnaire and evaluation of the medical records of 150 patients referred to the hepatitis clinic, gastrointentrology and infectious disease wards of Imam Khomeini Hospital and the Iran Blood Transfusion Organization, Tehran, Iran. We used a sequential method for sampling. Data were analyzed using statistical software (SPSS ver. 11) and the chi-square test.

Results: From a total 150 patients, 133 were male and 17 female. Six cases (4%) had oral lichen planus. All patients with oral lichen planus were male and the buccal mucosa was the most common site.

Conclusions: According to this study, the prevalence of oral lichen planus in patients afflicted with HCV is higher than in the normal population. We should pay more attention to oral lichen planus as one of the extrahepatic manifestations of hepatitis C.

---

Background: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO) synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO) can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need.

Methods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated.

Results: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need.

Conclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.

---

Background: Acute hepatitis is upon serious complications of halothane usage, can be associated with 50% mortality in severe cases. Use of halothane as inhalational anesthetic or use of it for maintenance of anesthesia is restricted/ prohibited in USA and most European countries. The occurrence of icterus and elevated liver enzymes after halothane anesthesia may be due to the drug induced hepatitis.

Case report: we report a 28 year old woman with acute hepatitis after cesarean section under halothane anesthesia, fortunately discharged to home 40 days after that. Other causes of hepatitis became role out in the patient.

Results: The usage of halothane should be restricted/ prohibited in our country because of its potentially serious and fatal complications and so existence of more safe but expensive alternatives.

---

Background: Trauma is a common problem in the world, predominately affecting young adults. Considering the high mortality rate in patients suffering from thoracic trauma, the condition is considered to be extremely important. The purpose of this study was to evaluate the prevalence and the epidemiology of chest trauma as well as the severity of the resulted injury in Tehran, Iran.

Methods: This prospective, descriptive study was conducted on patients admitted to three medical centers in Tehran during June 1997 and 1998 due to chest trauma. The data on the demographic information of the patients, the mechanism of the trauma and the severity of the injury were collected and analyzed.

Results: Three hundred forty two patients were admitted to hospital due to thoracic trauma the majority of which were male adults. Blunt trauma especially secondary to motor vehicle accidents were the most frequent cause of chest injury in the studied patients. In 280(82%) of the cases, another form of trauma was also reported. Chest wall injury was the most common type of thoracic trauma in these patients. The trauma was reported to be mild in 181(53%) of the patients (ISS<7). Only 42(12%) patients required surgical intervention. The overall mortality rate was 14% which was reported to be ISS- related.

Conclusion: Chest injury is quite prevalent among trauma patients and is associated with other injuries in a considerable number of the patients. This type of trauma is associated with a high mortality rate among elderly and therefore needs special attention and care.

---

Background: The papanicolaou (pap) smear has been used to screen cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional pap smear. Ideally, these new tests will increase the early detection of meaningful pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results.

Methods: In this prospective study the result of Liquid- based cytology smears (Liquid prep method) compared with conventional pap smears in terms of adequacy and ASC diagnosis in 289 patients in pathology department of mirza kochak khan hospital (Tehran, 2005- 2006). The smears were interpreted based on Bethesda system 2001.

Results: In conventional pap smear method, the number of occasions of unsatisfactory smear was 24(5%). In Liquid- based cytology method 66(22.8%) smears were unsatisfactory, In which difference between unsatisfactory groups were statistically significant (p<0.05), Also ASC diagnosis in conventional method 5(1.8%) as compared with Liquid- based cytology 6(2.1%), was not statistically significant (p>0.05).

Conclusions: There was no significant difference between two methods in term of ASC diagnosis but in conventional method adequacy of specimen was significantly better as compared with this Liquid- based cytology method.

---

Gliomas include a group of primary central nervous system (CNS) neoplasms with characteristics of neuroglial cells (eg, astrocytes, oligodendrocytes). The gliomas are classified commonly to WHO grade I-IV gliomas. The grading is based on the presence of nuclear atypia, vascular proliferation, mitoses, and necrosis. The malignant gliomas are progressive brain tumors that are divided into anaplastic gliomas and glioblastoma based upon their histopathologic features. Today, different modalities such as surgery, radiation therapy (in the form of external beam radiation or the stereotactic approach using radiosurgery) and chemotherapy have been used for the treatment of gliom's tomors but unfortunately the prognosis and survival rate is poor in most of patients. The survival depends on the tumor's type, size, location and the patient's age. We reviewed the prognostic factors, diagnostic modalities and surgical management of patients with gliomas.

---

Background: The sensitivity and specificity of body mass index (BMI) percentiles of CDC2000 standard which is used in determining obesity in Iranian children was compared with child real obesity identified by fat mass index (FMI) and obesity status in these children based on BMI and FMI was compared too.
Methods: Weight, height and triceps skinfold (TSF) thickness were measured in 1800 primary school children in Sabzevar, Iran. Fat mass (estimated from TSF) and weight were divided by height squared to calculate FMI and BMI, respectively. FMI at or above the 90th percentile of age- and sex- specific data in this study was considered as criterion for real obesity, and BMI≥95th and 85thResults: Based on the CDC cut-offs, the prevalence of overweight and obesity in our children were 7.9% and 4.8%, respectively. From the real obese and non-obese children identified by the FMI, 43.3% and 0.6% were identified as obese according to BMI, respectively. In addition, the sensitivity and specificity of 90th percentile of BMI to identify children as obese, were 71.1% and 98% respectively.
Conclusions: The efficacy of BMI in determining childhood obesity may be less than expected and it appears that FMI in comparison with BMI, is a better indicator of obesity in children, but more studies in this area are required.

---

Background: Osteoarthritis is the most common form of arthritis in the world. This study presents the evidence on the prevalence of symptomatic hand osteoarthritis in urban community. To add to the evidence on the prevalence of symptomatic hand osteoarthritis in urban community.
Methods: Inhabitants (age≥15 yrs) in 22 randomly selected districts (Tehran) participated in a Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) evaluating major rheumatic disorders, including osteoarthritis. Eventually, 10, 291 inhabitants completed a Questionnaire (75% response-rate). Trained interviewers asked participants whether they had had any pain, swelling, tenderness, or morning stiffness in the right/ left hand during previous seven days. Participants underwent a complete physical examination if they had any musculoskeletal complaint or extra-articular manifestation of rheumatic disease. Osteoarthritis was defined as presence of palpable nodules (Heberden’s/ Bouchard’s nodes, CMC1’s squaring), pain, tenderness, swelling, or a combination of them on that joint (DIP-PIP-MCP-CMC1). Clinical hand osteoarthritis was positive if at least one joint showed osteoarthritis.
Results: Symptomatic hand osteoarthritis was present in 2.8%(CI 2.3-3.4) (52.6% female, mean age 37.1±16.3). Prevalence was higher in females (4.3% vs. 1.3%, p=0.000) and increased with age (0.1% in people <30 versus 23% in people >70, p=0.000). The most common signs in the DIP, PIP and CMC1 joints were bony enlargement, followed by tenderness and pain on movement.
Conclusions: our study confirms the evidence of high prevalence of symptomatic hand osteoarthritis in an urban community. The prevalence, pattern of hand joints involvement and relationship with age and sex in this study performed in an Eastern community resemble those in Westerners, which calls for further attention by appropriate services.

---

Background: Sepsis is the leading cause of hospital admission and mortality. One marker for differentiation between infectious and non-infectious diseases is serum procalcitonin (PCT) level. The goal of this study was evaluation of serum procalcitonin level for differentiation among infectious & non infectious systemic inflammatory response syndrome (SIRS).
Methods: In a cross sectional study 263 patients with probable symptoms of sepsis that admitted to emergency department of Imam Khomeini Hospital Complex in Tehran, Iran, between 2006 and 2008, were evaluated for serum procalcitonin level by semi quantitative method. The clinical findings, demographic and laboratory data were identified by reviewing the medical notes.
Results: A total of 263 patients enrolled in the study. Mean age in study patients was 46.9 year (20.7) and most of the patients were male (65.8%). In 104 patients (39.5%) serum procalcitonin level was less than 0.5 (ng/ml), in 49 patients (18.6%) was between 0.5 and 2 (ng/ml), in 74 patients (28.1%) was between 2 and 10 (ng/ml) and in 36 patients (13.8%) was more than 10 (ng/ml). Sixty three patients (60.6%) with PCT<0.5ng/ml, had non-infectious SIRS, while all patients with PCT≥10ng/ml, had infectious SIRS. Procalcitonin level in patients with infectious SIRS was significantly more than patients with non-infectious SIRS (p<0.0001). Sensitivity of test for cut off point of 0.5, 2 and 10 (ng/ml) were 89.2%, 67.1% and 22.8% respectively, and its specificity for cut off points of 0.5, two and 10 were 82.9%, 96.2% and 100% respectively.
Conclusions: Procalcitonin level in combination with an appropriate clinical assessment can help us in beginning of antibiotic therapy timely and improve diagnostic and prognostic evaluation of patients with sepsis.

---

Background : Open fractures are associated with an increased risk of infection and healing complications. Management of open fractures is based on the following principles: assessment of the patient, classification of the injury, antibiotic therapy, debridement and wound management, Fracture stabilization, early bonegrafting, and supplemental procedures to achieve healing.
Methods : In a case- control retrospective study we evaluated 33 patients with open tibial fracture (type two gustillo) who were admitted in sina General hospital in Tehran, Iran during years 1999-2009 and were treated uniformly with external fixation as primary treatment in our center as case group and the other 33 patients with the same method and another 33 patients who had not been infected as control group. W e compared the folders of case and control groups retrospectively. 
Results : There was no statisticant difference between two groups in mean age, gender, the mechanism of trauma and body mass index (p >0.05 ), while statistically significant difference between them in smoking habitus, blood transfusion, first debridment time, diabet mellitus, femoral shaft fracture (p <0.05 ).
Conclusions: Accompanying femoral fracture is the sign of high energy trauma and it is logical that it is an important risk factor for infection. In our study the time of the first debridment stablished as a significant factor influencing the infection rate in tibial open fracture. In some studies smoking had been recognized as a significant factor influencing in tibial bone open fracture our study reveals the same.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma.
Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site.
Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415).
Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis.

---

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cerebrovascular accidents are the most common complications in premature neonates (gestational age <37 weeks). Intraventricular hemorrhage (IVH) and hydrocephaly are the most common presentations of these accidents. Premature neonates less than 28 week age or 1000 gr have maximum risk of cerebrovascular accidents with prevalence of 30 percent. Early screening in high risk pregnancies with real-time ultrasonography can detect these lesions and affect on final prognosis. The purpose of this study is evaluation of brain ultrasonongraphic findings of 60 premature neonates born in Yazd University Hospitals, Yazd, Iran and relationship between these findings and delivery types.
Methods: In this descriptive cross sectional study 60 cases of premature neonates (less than 37 week) who were born from January to July 2007 in Yazd hospitals were evaluated ultrasonographically to detect cerebrovascular accidents.
Results: Among 60 premature neonates, 52(86.67%) were low birth weight and 8(13.33%) neonates weighted more than 2500gr. IVH was seen in five (9.6%) LBW neonates and hydrocephaly was seen in five (9.6%) LBW neonates. One LBW neonate (1.9%) had haloprocencephaly. Eight normal weight neonates had no abnormal ultrasonographic findings.
Conclusion: All factors that induce preterm delivery and high risk pregnancies can increase cerebrovascular accidents in premature infants. Neonatal weight had most powerful relationship with neonatal ultrasonograohic findings.