Tehran University Medical Journal

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This is a study on 62 G6PD patients hospitalized in Bahrami hospital between 1993 to 1995. Favea was the oxidant agent causing acute hemolysis in more than 90 percent of patients. Most of acute hemolysis occurred in spring, the season of high consumption of favea. More than 60 percent of patients had moderate to severe hemolysis with Hb less than 7 gr/dL. According to WHO reports, the incidence of G6PD is 7-12% in Iran and it is favism type. It is suggestive to prevent parents of sugh patients of favea consumption, which in turn decreases the rate of acute hemolysis, its complications, complications of transfusion and hospitalization in endemic area of Iran.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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This syndrome is a very rare neurological presentation which was first reported by Susac in 1975, and usually involves the young women with triad of: (1) Visual loss due to occlusion of retinal artery branches. (2) Subacute encephalopathy with psychic manifestation, personality disorders, involvement of the cortico-spianal tracts, pseudo-bulbar, focal or generalized seizures and myoclonic jerks. (3) Bilateral sensory neural hearing loss with tinnitus. All of the symptoms and signs are pathologically due to microinfarcts. It's pathogenesis is unknown. Brain biopsy shows multiple microinfarctions. Diagnosis of this syndrome is based on the clinical tiard, retinal angiography and neuroimaging studies. In this report, a young lady of 25 years old was referred to neurology ward of Imam Khomeini Hospital with above mentioned symptoms an signes and was recognized as a case of this syndrome.

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"Arterial Thromboembolism" is the most common cause of "Acute Arterial Ischemia" of extremities. In this study, It is attempted to collect retrospectively some documentary information of all "acute arterial thromboembolic occlusions of the limbs".
Materials and Methods: In descriptive retrograde study in Sina General hospital, all related records in this regard were collected from March 1991 to March 1997. To reveal the statistical outcomes and analysis the associations between them as well, the statistical tests like nonparametric ones were employed.
Results: Total number of the cases was 24 with " Acute Thromboembolic Arterial limb Ischemia" (3 in upper and 21 in lower limbs). The results were as follows: Female to male ratio =1/2, "Range of Age": 34-91, "Mode"=8th decade of life, "Mean"-64.48, "Etiology" Cardiac Origin in majority of cases ("A.F" in 57 percent) and Unknown Origin in 1/4 of cases. "Pain" was find in 95 percent, Grade HI ischemia in only 38 percent of patients on presentation and the others in Grade n. The most common "site of embolic occlusion" was "Femoral Ar." (76 percent). "Simultaneous Embolic Events" were fined in 29 percent. "Embolectomy" was performed in 79 percent (84 percent success rate) and "Primary Amputation" in 12.5 percent. "In hospital Mortality Rate" was fined in 24 percent and "Limb Salvage rate" in 68 percent. In conclusion, there were some logic relationship only between "Limb Salvage rate" and "Ischemic Grading" and also "Delayed diagnosis". There was also some significant direct relationship between "Mortality rate" and "Concomitant Embolic events".
Conclusion: This study was an explorative one that paves the way for further complementary investigations. Although there are many recommendations due to upgrading knowledge, attitude and practice of physicians as well as lay people Besides, the upgrading of educational and curative facilities should not be neglected.

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Background: Urinary tract infection is a common bacterial infection in children and may lead to irreversible renal damage. TC 99-m Dimercaptosuccinic acid renal scintigraphy is the most sensitive method for diagnosing acute pyelonephritis. We designed a study to evaluate the ability of DMSA scan and ultrasonography to detect renal paranchymal lesion.

Materials and Methods: 62 children 1 month to 12 years of age with the first episode of acute pyelonephritis were prospectively studied with DMSA scan and ultrasonography during acute phase of infection. A Voiding Cystourethrogram was performed in 60 children when urine culture became negative. Children with renal paranchymal changes were older at the time of acute pyelonephritis (P=0.04) but no difference was found between the groups with regard to levels of CRP, ESR (P>0.05).

Results: Changes on the DMSA scan were found in 106 (85.5 percent) kidneys of 62 children but ultrasonography showed renal changes in 19.4 percent (sensitivity=20 percent, specificity=83 percent) (Kappa=0.06). Vesicoureteric reflux was found in 14 children (23.3 percent) but 83 percent of the affected kidneys were drained by non-refluxing ureters.

Conclusion: It is concluded that DMSA scan is more sensitive than ultrasonography in detecting renal paranchymal changes in acute pyelonephritis and we found out that renal paranchymal changes after acute pyelonephritis is common, even in those without VUR.

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Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors.

 Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain.

Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS.

 Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.

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Background: Using the systemic opioids in pain relief has been known during the history. Several evidences indicate that exogenous opioids such as morphine can produce anti-nociceptive effects by interacting with local opioid receptors in peripheral inflamed tissues in addition to analgesic effects of morphine, less clear is potential anti-inflammatory effects of it.

Materials and Methods: In the present study we examined effects of intra-peritoneal (i.p.) injection of morphine (7 mg/kg) on carrageenan (0.05 ml, 3% W/V in saline) induced paw edema in mice.

Results: Carrageenan induced paw edema were measured by mercury plethysmometer and was maximal at hour 3 and pretreatment with morphine could reduce the edema significantly. At the same time the serum levels of interleukin-1 alpha (IL-1α) were increased. Pretreatment with naloxone (2&10 mg/kg, i.p.) at 45 min before and 165 min after carrageenan, respectively, blocked the effects of morphine sulfate on edema in each groups. Pretreatment with naloxone abolished morphine anti-inflammatory while decreased IL-1α serum levels, significantly. Although, administration of anti mouse IL-1α (7, 14 & 28 µg/mice, i.p.) abolished morphine anti-inflammatory effects.

Conclusion: These findings showed that increase in serum levels of IL-1α play important roles in anti-inflammatory effect of morphine. The results indicated that morphine exert significant anti-inflammatory activity. Presumably, the anti-inflammatory action of morphine may be due to change on the cytokine production and/or release by host immune system.

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Background and Aim: Quality of care and its concordance with scientific evidence has a significant role in improvement of prognosis in patients with acute coronary syndrome (ACS). The present study was performed to evaluate the quality of care in a TUMS-affiliated hospital.

Materials and Methods: The quality indicators of the process and outcome of care according to guidelines of the MONICA project was used in this study. 320 cases with primary impression of ACS (including 80 cases from each trimester during Aug-2003 to Jul-2004) were evaluated according to MONICA standard definitions of diagnosis, provided care and survival in 28th day after heart attack.

Results: The Equivalent Treatment Score (ETS) was 43.4 percent (95%CI: 32.86-53.94) and the Weighted Treatment Score (WTS) was 22.2 percent (95%CI: 13.36-31.03) in patients with definite myocardial infarction. The 28-day case fatality among the evaluated patients was 9.09 percent (95%CI: 5.85-12.33).

Conclusion: Although the measures of quality of care in this patient setting were acceptable in comparison with MONICA collaborative centers, however the difference between ways of hospital sampling (in the present study) and the population-based method (applied in the MONICA populations) should be taken in to consideration. Adding pre-hospital fatal events to this data set will decrease the precision of quality measures.

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Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.

Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test.

Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).

Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

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Background: Acute bacterial sinusitis is one of the most common causes for antibacterial treatment. Oral Penbactam (ampicillin- sulbactum or Sultamicillin) is a broad spectrum antibiotic and it has no significant side effect. To our knowledge, this is the first study in Iran in which, oral Penbactam has been prescribed for patients with acute bacterial sinusitis.

Methods: A randomized clinical trial was performed on 44 outpatients diagnosed with acute bacterial sinusitis in Amir- Aalam Hospital from March 2003-2004 to August 2004. Patients were randomized in 2 group: 23 to oral Penbactam (375 mg twice daily), and 21 to oral Co-amoxicolav (625 mg three times daily). Duration of treatment was 10 days for both groups.

Results: Both groups showed a significant clinical improvement after 10 days of treatment. In the Penbactam group, 19 of 23 (86.36%) and in the Co-amoxicolav group ,18 of 21 (85.71%) showed clinical improvement. In the Penbactam group, one patient (4.3 %) developed diarrhea and the medication was discontinued.

Conclusion: Oral Penbactam is an effective and safe antibiotic in the treatment of acute bacterial sinusitis and could be used as an alternative medication for acute bacterial sinusitis.

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Background: The early diagnosis of acute appendicitis before progression to gangrene or abscess formation is recognized as important to minimize morbidity from this common disease process. The aim of this study was to assess the value of different risk factors in the diagnosis of perforation.
Methods: This descriptive-analytic and retrospective study was conducted to investigate epidemiological characteristics in patients with perforated and non-perforated appendicitis. A series of 1311 patients who were operated on for acute appendicitis between years 1380-1382 in Shahid Beheshti and Yahya-nejad hospitals were reviewed.. Data gathered included age at operation, gender, care sought prior to admission for appendectomy including antibiotic and analgesic therapy, time of presentation in the year, duration of symptoms, signs and symptoms at the time of admission, and the patient’s living area.
Results: One hundred twenty one of 1311 patients (9%) had perforated appendicitis and 1190 patients (91%) had unperforated appendicitis. Presentation and referral in the first 6-month was associated with higher perforation rate. Patients from rural area showed a higher rate of perforations. The perforation rate was significantly higher in elderly patients (>65 year). When the duration of symptoms was more than 12 hours at presentation, the risk of perforation showed a five-fold increase. 30.7% of perforated cases had used antibiotic or sedative before referring to the hospital.
Conclusion: Appendiceal perforation continues to be a complication in patients with acute appendicitis and increased in the frequency as the age of the patients increase and the duration of symptoms lengthen. We also found that the perforation rate is higher in patients from rural area and in whom present in the first 6-month of the year, a finding that was not reported so far.

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Background: The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. The objective of this study was to study prevalence of inflammatory factors particularly C-reactive protein (CRP) in hemodialysis patients.
Methods: We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP (agglutination method), albumin (bromocresol green method) and ferritin (ELISA) were measured in all patients.
Results: One hundred and twenty five patients including 53 (44.1%) men and 72 (55.9%) women were enrolled in this study. Fourteen patients (11.2%) had hypoalbuminemia, 81 (64.8%) had high serum ferritin, and 57 subjects (45.6%) were CRP positive.
Conclusion: According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance.

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Background: Cardiovascular problems including arterial hypertension, coronary artery diseases, congestive heart failure are prevalent among chronic hemodialyzed patients. Ultrafiltration of hemodialyzed patient's serum, which culminating in intravascular volume reduction, is frequently used during hemodialysis. One of the restrictions of the echocardiographic evaluation of the diastolic heart function is the intravascular volume dependency of some echocardiographic parameters. In this study we have evaluated the volume dependency of certain echocardiography parameters in chronically hemodialyzed patients.

Methods: Thirteen patients undergoing chronic hemodialysis in Ghaem Hospital Hemodialysis Center in Mashhad, Iran, were evaluated one hour before and immediately after hemodialysis for the following: all diastolic echocardiographic parameters, left ventricular function, left ventricular systolic function, inferior vena cava (IVC) diameter and IVC collapsibility with inspiration, and systolic and diastolic blood pressure. The echocardiographic parameters were analyzed using the paired Student's t-test.

Results: With hemodialysis, there was no significant change in left ventricular function, A wave amplitude and E/F slope, however, there was a significant reduction of the E wave amplitude, increment in E wave deceleration time (p= 0.001, t=-4.14) and a decrease in the E/A ratio (p=0.03, t=2.46). Tissue Doppler echocardiography showed no significant change in mitral annular diastolic motion, E'/A' waves, with hemodialysis (p=0.728, t= - 0.356), although there was a reduction of the E/E' ratio.

Conclusion: Tissue Doppler imaging and color M-mode echocardiographic parameters are independent of the intravascular value status. With no change associated with hemodialysis, these parameters can be used as reliable criteria for evaluating ventricular diastolic function even when the volume status varies.

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Background: Despite the overwhelming progress that has been accomplished in the prevention of mortality due to cardiovascular disease, coronary artery disease (CAD) is the leading cause of death in the world.

The aim of this study was to compare of the effects of enoxaparin versus unfractionated heparin (UFH) on major clinical events, including mortality, myocardial infarction (MI), and recurrent angina, as well as bleeding in patients with non ST elevation acute coronary syndrome (NSTEACS). We also studied the need for coronary angiography and revascularization (PCI or CABG) in these patients.

Method: Two-hundred patients were enrolled in this study, 100 of whom received intravenous UFH (an initial bolus of 5000 U followed by continuous infusion of 1000 U/h) and 100 received enoxaparin subcutaneous injections of 1mg/kg twice daily for a minimum of 72 h. During their admission we recorded data regarding death, MI, recurrent angina, need for angiography and revascularization, and major and minor bleeding.

Results: The incidence of recurrent angina, total mortality and the need for revascularization were significantly lower in patients receiving enoxaparin compared to those receiving UFH, at 17% vs. 39% (p=0.002), 0% vs. 3% (p=0.035), 14% vs. 33% (p=0.001), respectively. However, there was no significant difference regarding the incidence of MI, major bleeding and cardiac death between the two groups.

Conclusions: This study showed that, in patients with NSTEACS, enoxaparin was superior to UFH regarding the prevention of major in-hospital clinical events, especially recurrent angina and the need for revascularization. We therefore recommend enoxaparin as an alternative antithrombotic agent to UFH in patients with NSTEACS.

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Background: Ureteral obstruction, leading to urinary stasis and elevated pressure in the proximal part of urinary tract, causes progressive renal dysfunction. This study was designed to evaluate the status of oxidative stress and metabolic defect in acute unilateral ureteral obstruction (UUO).

Methods: Experiments were performed on three groups of male Sprague-Dawley rats (n=10 in each group). In the UUO group, rats were lightly anesthetized by ether and the left ureter was occluded by means of a sterile surgical procedure. Twenty-four hours after UUO-induction, both kidneys were removed and stored at -70 °C. In the sham group, anesthesia and surgery were performed without ureteral occlusion, and the control group received no surgical procedure. The kidney samples were assessed to measure the levels of ATP and ADP by the luciferin-luciferase method for determining metabolic status. In addition, the levels of malondialdehyde (MDA) and ferric reducing/antioxidant power (FRAP) of the kidneys were measured to evaluate the redox state. Data are expressed as means ±SEM per gram of kidney weight (gKW). The comparisons were performed using paired t-test for intra-group analysis, and ANOVA followed by Duncan's post-hoc test and then LSD test for inter-group analysis. Significance was taken at p<0.05.

Results: The comparisons between the UUO and sham groups indicated that 24 hours of UUO increased levels of MDA (51.42±1.86 vs. 38.64±1.02 nmol/gKW, respectively p<0.001) and ADP (0.67±0.04 vs. 0.47±0.045 µmol/gKW, respectively p<0.01), but decreased levels of FRAP (2.44±0.18 vs. 4.28±0.27 µmol/gKW, respectively), ATP (1.09±0.10 vs. 2.26±0.19 µmol/gKW, respectively) and ATP/ADP ratio (1.64±0.14 vs. 5.11±0.56, respectively) in the obstructed kidneys, all p<0.001. In the non-obstructed kidneys, the levels of ATP and ADP were higher (p<0.01 and p<0.001, respectively), while the levels of MDA and ATP/ADP ratio were equal to those of the sham group.

Conclusion: Twenty-four hours of acute UUO induces oxidative stress and reduces the aerobic metabolism in obstructed kidneys, whereas non-obstructed kidneys with a normal redox state show the higher levels of metabolism.

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Background: About one-forth of the patients admitted to the emergency department complain of acute abdominal pain. According to surgical records, most surgeons believe that pain relief for these patients may interfere with the clinical examinations and the final diagnoses. As a result, analgesics are withheld in patients with acute abdominal pain until the determination of a definite diagnosis and suitable management plan. The purpose of this study was to evaluate the effect of analgesics on the evaluation course and treatment in acute abdomen.

Methods: Two hundred patients at a surgical emergency department with acute abdominal pain were enrolled in this prospective study and randomly divided into two groups at the time of admission. The case group consisted of 98 patients who received intravenous analgesia immediately after admission. The other 102 patients in the control group did not receive analgesia until a definite diagnosis was made. Diagnostic and therapeutic procedures were similar between the two groups. The primary and final diagnoses, and the time intervals between the admission and definite diagnosis, and that between admission and surgery were gathered and analyzed.

Results: The mean time to definitive diagnosis was 1.7 and 2.04 hours in the case and control groups, respectively. There was no statistically significant relationship between analgesic use and gender, age, time to definite diagnosis, or accuracy of the diagnosis. In fact, the time required to achieve a definite diagnosis and the time between admission and surgery were less in the group that had received analgesics.

Conclusions: In spite of the fact that analgesics remove the very symptoms that brings patients to the emergency room, appropriate use of analgesics does not reduce diagnostic efficiency for patients with acute abdominal pain.

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Background: While excellent organ quality and ideal transplant conditions eliminate many of the known factors that compromise initial graft function (IGF), slow graft function (SGF), still occurs after living donor kidney transplantation (LDKT). The aim of our current study is determination SGF frequency and its risk factors in LDKT 

Methods: In this prospective study, between April 2004 and March 2006, data were collected on 340 LDKT, in Baghiyattallah Hospital, Tehran. Recipients were analyzed in two groups based on initial graft function (IGF): Creatinine <3 mg/dl 5 day after transplantation, SGF: Creatinine ≥ 3 mg/dl 5 day after transplantation with out dialysis in the first week. Donors' and recipients' characteristics and recipient lab. data were compared in two groups by chi-square, Mann-whitney & independent samples T-test.

Results: The incidence of SGF was 22 (6.2%) and IGF 318 (89.8%), Recipients' BMI in IGF were 22.1±3.9 and in SGF were 25.3±3.8 (P=0.001 95% Cl 1.097-1.401 OR= 1.24). SGF relative frequency in female donors is more than male donors. A multivariate analysis model confirms this significant difference. (P=0.044 95% Cl 1.028-7.971 OR= 2.862). SGF relative frequency in PRA (Panel Reactive Antibody) positive recipients are more than negative ones. A multivariate analysis model confirms this significant difference. (P=0.007 95%Cl 1.755-35.280 OR= 7.849). Recipients' age and donors' BMI are significant in univariate analysis (P=0.002 & P=0.029 respectively) but multivariate analysis model dose not confirm those significance. Serum ca & P & PTH levels don't have significant difference between IGF & SGF. Using calcium channels blockers have not a protective effect.

Conclusions: We conclude that negative PRA and lower recipient BMI have protective effects on SGF. Recipients with female donors have higher chance to develop SGF. We recommend recipients reduce their BMI before transplantation. The male donors are preferred to female ones.

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Background: Acute respiratory tract infections, both bacterial and viral, cause 4.5 million childhood deaths worldwide, most of which occur in developing countries. Parainfluenza viruses, of the paramyxoviridae family, are among the common causes of acute respiratory infections, giving rise to 30% of respiratory infections in children before school age. The four parainfluenza viruses that cause a spectrum of respiratory illness in humans are designated as human para influenza virus-1 through 4. Spreading from the respiratory tract by aerosolized secretions or direct hand contact with secretions, parainfluenza viruses replicate in the respiratory epithelium without evidence of systemic spread. The destruction of cells in the upper airways can lead to secondary bacterial invasion and resultant bacterial tracheitis. Eustachian tube obstruction can lead to secondary bacterial invasion of the middle ear space and acute otitis media. In otherwise healthy children, the majority of illnesses remain in the upper respiratory tract. As with many viruses, three approaches to the diagnosis of parainfluenza virus are currently used: viral culture, detection of viral antigen or nucleic acid, and serologic analysis. The gold standard remains the isolation of virus in tissue culture.

Methods: This descriptive case-series study was conducted from January 2003 to January 2004, and included 96 children five years of age and younger. To determine the relative frequency of parainfluenza respiratory tract infection, the nasopharyngeal secretions were studied by immunofluorescent antibody (IFA) assay. Seasonal incidence, age distribution and clinical signs and symptoms of this infection were also recorded.

Results: Among our study group, the relative frequency of parainfluenza respiratory infection was 26%, most commonly in children aged 25-36 months and in autumn. Cough (84%) and rhinorrhea (96%) were the most common symptoms, with fever (68%) as the most common sign in our patients. Pharyngotonsilitis was the most common (40%) clinical manifestation in our patients.

Conclusions: According to above data, patient age and the frequency of parainfluenza infection were similar to other studies.

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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.

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Background: Acute appendicitis is one of the most common abdominal emergencies. Many studies comparing the two routes of open and laparoscopic appendectomy have been performed comparing the duration of each operation, duration of hospitalization, amount of post-operative pain medication required and infectious complications were the most commonly evaluated factors.

Methods: This clinical trial study, performed between March 2005 and March 2006 at Golestan and Imam Khomayni hospitals in Ahvaz, Iran, included 100 patients. Open appendectomy and laparoscopic appendectomy were carried out on 50 patients each. Duration of surgery and hospitalization, amount of pain medication and infectious complications were compared, with chi-square, ANOVA and t-test used for statistical analysis.

Results: The average length of hospital stay for laparoscopic appendectomy was 44.48 hours and for open appendectomy was 54.80 hours (p<0.01). The average of amount of pain medication for laparoscopic appendectomy was 2.40 doses and for open appendectomy was 30.46 doses (p<0.01). The laparoscopic and open procedures averaged 31.8 and 35.2 minutes, respectively (p=0.5). Only one (2%) laparoscopic case had infection, while four (8%) open appendectomy subjects suffered from this complication. Patients who underwent laparoscopic appendectomy had no intra-abdominal abscesses.

Conclusions: Duration of hospitalization was statistically much shorter using the laparoscopic appendectomy than that of the open procedure (P<1%). The amount of pain medication administered was also statistically less in the laparoscopic procedure (P<1%). However, the amount of time to complete each procedure was not statistically different. Most importantly, complications such as wound infection and intra-abdominal abscess were remarkably less using laparoscopy. We recommend laparoscopic appendectomy over open appendectomy.