احمد انحصاری

The use of Focused Assessment with Sonography in Trauma (FAST) in blunt abdominal trauma has various advantages and disadvantages. Considering the importance of timely diagnosis of blunt abdominal traumas, the question is whether it is possible to manage these patients only by performing FAST in the emergency room? Therefore, this study was conducted with the aim of comparing the diagnostic accuracy of FAST with CT-Scan in patients with blunt abdominal trauma.

This cross-sectional study was conducted on 400 patients with blunt abdominal trauma referred to the emergency department of affiliated teaching hospitals of Kerman University of Medical Sciences in 2020. Data were obtained by examining the medical records of the patients. The results of FAST were compared with the results of abdominal and pelvic CT scan (as a gold standard), diagnostic peritoneal lavage (DPL) and laparotomy results (as a gold standard in case of unclear CT-Scan results) and the sensitivity, specificity, the positive and negative predictive value and its accuracy were determined.

The mean age of the participants was 36.27±10.44 years. 72.5% of them were men. The most common organ involved was the liver (73%). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FAST were equal to 75.1 (73.4-79.6), 91.7 (89.4-94.7), 94.1 (92.7-96.3), 77.2 (75.7-79.6) and 83.7 (80.3-85.5), respectively. Also, the odds ratio of FAST in detecting free fluid was 1335.3, injury to intra-abdominal organs was 7.53 and it was 28.9 for all cases.

The results of the study showed that FAST sonography in the emergency room is a suitable method for diagnosing free intra-abdominal fluid following blunt trauma, but it cannot properly diagnose the location of the injury.

Vesicoureteral reflux (urinary reflux) is one of the most common congenital anomalies in children. This study aimed to compare the ureteral opening distance from the midline in children with vesicoureteral reflux (VUR) and healthy children

This cross-sectional study was performed on the children with pyelonephritis who were referred to Afzalipour Hospital in Kerman, Iran from August 2019 to August 2020. Twenty children with vesicoureteral reflux (urinary reflux) and twenty healthy children were randomly selected. Then children with vesicoureteral reflux (urinary reflux) and healthy children were divided into two groups. The distance from the ureter to the midline in these children was then measured by a radiologist with a Philips affinity 70 ultrasound machine.

In both groups (healthy children and ones with vesicoureteral reflux), ninety-five percent of the children were girls. The mean age of the children in the second group (the children with urinary reflux) was 5.8±2.58 years and the mean age of the children in the first group (the healthy children) was 4.75±1.54 years. The mean age difference between the children with urinary reflux and healthy children was not statistically significant (P=0.127). The mean distance of the ureter from the midline in children with vesicoureteral reflux was 11.44±2.60 mm and the mean distance of the ureter from the midline in healthy children was 9.32±2.74 mm. The mean difference distance of the ureter from the midline in children with vesicoureteral reflux (VUR) and healthy children was statistically significant (P=0.002).

Considering that the distance between the ureter and the midline in patients with urinary reflux is significantly longer than non-reflux ureters, it can be used as a non-invasive method for the diagnosis of vesicoureteral reflux (urinary reflux) in children.

Manipulating of training variables with the aim to augment muscle metabolic stress could result in muscle hypertrophy.The purpose of the current study was to present a lacto-resistance training method and to compare its effect on rectus femoris muscle hypertrophy with traditional resistance training.

Twenty- four male professional bodybuilders were randomly divided into three groups based on muscle cross-section area: lacto-resistance (n=8), traditional-resistance (n=8) and control (n=8). The comparison of metabolic stress between two types of exercise was done using monitoring blood lactate and urea following squat exercise. Muscle cross-section area and strength were measured by sonography and one repetition maximum (1RM), respectively, before and after 4 weeks of resistance training.  Analysis of covariance was used to evaluate inter – and intra groups differences.

Compared to the baseline values, blood lactate levels significantly increased following squat exercise in both lacto-resistance (10.76±1.35) and traditional–resistance (7.70±1.16) groups, and the changes in blood lactate was significant between two groups (P˂0.05). After 4 weeks of resistance training, the changes in rectus femoris muscle cross-section had a significant difference only in lacto-resistance group in comparison to its own baseline values (P˂0.05) and the control group (P˂0.05). Compared to the baseline values, 1RM measured in squat exercise significantly increased in both experimental groups (P˂0.01), the difference between groups was significant, and lacto-resistance group had higher values than those from the traditional-resistance group (P˂0.05).

Compared to the traditional resistance training, Lacto-resistance training induces a higher metabolic stress and its effects on muscle hypertrophy and strength are more impressive.

Diabetes is a very important factor for stroke due to blocked blood vessels. It can involve systemic and cerebrovascular arteries at the same time via microangiopathy and macroangiopathy. This project aimed to compare the intima-media thickness of carotid artery in children with diabetes type and the control group.
In this case-control study, 50 children with the age of 5-18 years were enrolled in two equal groups of patients and controls. After obtaining informed consent and completing the demographic data, carotid artery ultrasound, lipid profile test and checking random blood pressure was conducted for the subjects. Then, the data were statistically analyzed using SPSS software.
The mean intima-media thickness of the carotid artery was 0.45 ± 0.09 and 0.38 ± 0.06 in control and patient groups, respectively. There was a statistically significant difference between the two groups (P = 0.004).
The intima-media thickness of the carotid artery and serum lipid profiles in children with diabetes was significantly higher than the control group. In addition, in children with diabetes, the systolic blood pressure was significantly correlated with the increased intima-media thickness of the carotid artery.

Doppler ultrasonography is the best tool for assessment of transplanted kidneys’ vascular status. On the other hand cyclosporine A widely consume to prevent graft rejection، has some vasoconstriction effects influence the Doppler parameters. To date، there has been little agreement on this effect. This paper will focus on the evaluation of whether cyclosporine A was affect the Doppler parameters. A cross-sectional study was performed on 31 stable patients، between 6-18 months after transplantation. All patients were received immunocompromised treatment including cyclosporine A. Interarenal Doppler indices، resistive index (RI) and pulsatility index and end diastolic velocity (EDV) and peak systolic velocity (PSV) were measured at interlobar artery level before and 2 hour after (peak serum level) the oral intake of cyclosporine A. Data analysis were made by SPSS software to estimate the influence of cyclosporine A on the Doppler parameters. compared with Doppler parameters before and 2hour after cyclosporine A، among patients with mean serum creatinin levels about 1. 3، values remained unchanged. In this study، consumption of cyclosporine A dose not lead to acute rise in ultrasonographic Doppler indices.

Diagnosis of malignant lymphadenopathy is particularly important for treatment planning، staging before treatment and also for determination of prognosis. Various diagnostic procedures which are expensive and invasive are now used for distinguishing malignant from benign lymphadenopathies. Ultrasound has been proposed as a non- invasive، cost effective and available procedure compared with other procedures. This study was conducted to evaluate some ultra sound parameters in distinction between malignant and benign superficial lymphadenopathies. Lymph nodes of 100 patients who were candidates for pathological evaluation of their superficial lymphadenopathy were evaluated sonographically. The most accessible lymph nodes were marked and then biopsied and sonographic results were compared with pathologic ones، and the sensitivity and specificity of the test and the appropriate cut off point was determined based on the ROC curve and by SPSS 17. Of 100 evaluated nodes 55 nodes were benign and 45 nodes were malignant. The ratio of cortical thickness to medullary thickness was not significantly different between malignant and benign lymph nodes. There was a significant difference between blood supply pattern and average indices of PI (P=. 007) and RI (P<. 001) between benign and malignant lymph nodes. The best cutoff point of cortex thickness to differentiate malignant from benign lymphadenopathy with 62. 2٪ sensitivity and 72. 7٪ specificity and 70٪ accuracy was 7. 95 mm. The color Doppler criteria in combination with gray scale sonography can be very helpful in choosing patients for biopsy or FNA، but cannot fully replace pathological evaluation.

Women with history of gestational diabetes mellitus (GDM) are at risk for developing cardiovascular disease and metabolic syndrome. Carotid intima-media thickness (CIMT) is noninvasive marker of sub clinical atherosclerosis assessment. The aim of the present study was to assess relationship between GDM and increased CIMT. Twenty women with previous history of GDM and twenty women without it (as a control group) were included in the study. Two groups were matched based on their age, body mass index (BMI) and parity. CIMT was measured one year after delivery in two groups by B-mode sonography and compared with ultrasonic results of CIMT in mid- and late-gestational periods. CIMT in both groups increased in gestational period and decreased after delivery and this diminution was significant at late-gestational period in both groups and also significant at mid-gestational period in women with history of GDM. CIMT was significantly decreased one year after delivery in women with GDM

Sonography has enjoyed much attention as a noninvasive diagnostic tool for carpal tunnel syndrome in recent years. The aim of the present study was to assess the effect of anatomic variations of existence or absence of palmaris longus and fifth superficial flexor tendons on the sonographic measurement of median nerve surface area in healthy individuals’ wrists.

93 volunteers without any symptoms related to carpal tunnel syndrome underwent clinical evaluation for determining presence of tendons in both wrists and also, sonographic measurement of median nerve surface area.

In 22 of 186 hands (11.82%), there was absence of the palmaris longus tendon and absence of the fifth flexor was noted in 8 (4.30%). The median nerve surface area in the hands without palmaris longus was meaningfully less than the hands with it (P = 0.025), while the difference in the median nerve surface area was not statistically significant regarding the presence of the fifth flexor (P = 0.324).

Based on the findings of the present study, it seems that the median nerve surface, area as a sonographic finding, is probably related to presence or absence of the palmaris Longus tendon. So, those hands with the tendon present have larger surface areas. Also, it seems that this sonographic finding is not dependent on the presence of fifth superficial flexor tendon.

Teleradiology as an efficient way for avoiding unnecessary transfer of patients to special medical centers requires the images with digital format. However، in some developing countries، including Iran، imaging is being done using non digital devices. In such cases، changing analog images into digital ones can solve the problem. The method which is nowadays used for digitalizing analog images is using digitizers. Since in some regions digitizers are not available، using digital cameras as more accessible and cost-effective devices is a good choice، provided that the reliability of digital cameras for providing digital formats of radiographs would be confirmed. In this study، at first، 91 radiographs were randomly selected. These images were then shown to a radiologist and he was asked to interpret them. Next، a digital image was produced from each radiograph using a digital camera. After 40 days، these digital images were shown to the same radiologist and he was asked to interpret them. The interpretations were then analyzed and compared using Kappa agreement coefficient. The calculated Kappa agreement coefficient indicated a “Good” diagnostic agreement (kappa=0. 708، P <0. 000) between diagnoses made by using radiographs and their digitalized images. This study recommends that in cases of need for consultation with a specialist، capturing a digital image of radiograph by a digital camera and sending it to the spesialist via an internet line can be a reliable solution. This method can be used as a useful and cost-effective way of consultation with a radiologist who is working in another medical center.

Diabetes is the most common cause of renal insufficiency throughout the world. The main cause of renal failure in diabetic patients is microvascular endothelial injuries that is secondary to atherosclerosis and ischemia. The efficacy of renal Doppler indices such as resistive index (RI) and pulsetile index (PI) for the evaluation of intrarenal arteries has been shown. This study was done to determine the accuracy of RI and PI indices in earlier detection of renal involvement in type II diabetes. Sixty diabetic patients were divided into two groups of with microalbuminuria and without microalbuminuria. After determinig RI and PI, the two groups were compared by using independent t-test, fisher exact test and Pearson correlation and through SPSS 15. A statistically significant correlation was found between RI and positivity of microalbuminuria (P= 0.013). There was no correlation between RI and variables of age, sex and duration of diabetes. Moreover, 60% of cases without microalbuminuria had RI>0.7 that shows the diagnostic value of RI in earlier detection of renal failure in comparison to microalbuminoria test. Further studies for proving the efficacy of RI as the screening test for earlier detection of renal involvement in diabetes are recommended.

Non-alcoholic fatty liver disease (NAFLD) is a common hepatic disease, and attention is being paid to its association with obesity and metabolic syndrome. The goal of this study was to clarify the role of visceral fat accumulation in Nonalcoholic fatty liver disease. 105 patients with probable NAFLD based on clinical and paraclinical evaluations, in the absence of known etiologies of liver diseases were enrolled in the study. Ultrasound was performed for grading of fat accumulationin the liver and measurment of visceral fat thickness. Anthropometric indices and biochemical parameters measured too. Based on liver ultrasound, 13.3% had no evidence of fatty liver, the remaining had: 55.2% mild, 23.8% moderate and 7.6% severe fatty liver. Weight (P=0.001), body mass index (P=0.001), triglyceride (P=0.004), alanine aminotransferase (P=0.011), aspartate aminotransferase (P=0.009), waist circumference (P=0.001) and mesenteric fat thickness (P<0.001) were correlated significantly with high grade of fatty liver. On the other hand fasting blood glucose, total Cholestrol, LDL, HDL, total and direct bilirubin did not show significant correlation with grading of fatty liver. Mesenteric fat thickness was indipendent factor for hepatic steatosis (R=0.61). Visceral fat is strongly associated with hepatic steatosis. Sonographic measurment of mesenteric fat thickness is an easy, non-invasive and repetitive method for assessment of central obesity.

One of the complications of Beta-thalasemia major is hepatobiliary disorders for example cholelithiasis (Gallstone). In this study frequency of hepatobiliary ultra sound abnormal findings in 200 patients in Kerman was investigated. Among 200 patients, 11 (5.5%) had gallstone. The average age of patients without gallstone was 10.07±4.9 years and that of patients with gallstone was 16.1±5 years. Therefore significant difference in this regard is observed (P<0.05). Five patients (2.5%) had thickened wall in gall bladder, and their mean age was 12±2.5 years and that of patients with normal wall thickness was 10.3±5.1 years with no significant difference between two groups. Sixty three patients (31.5%) had history of splenectomy and 137 patients (68.5%) had not this history. Among 11 patients with gallstone, 9 patients had history of splenectomy and 2 patients had not this history with significant difference between the two groups (P<0.05). No significant difference was observed in the average serum ferritin in patients with gallstone (3786.7±941.4) and in the patients without gallstone (3147.03±1239.7).