فهرست مطالب حمیدرضا سعیدی بروجنی

Lumbar disc herniation is one of the most common causes of low back pain and after pulmonary disease, low back pain is the second most common reason to see a doctor. Diagnosis of lumbar disc herniation in a patient presenting with sciatica is based on history, clinical signs, physical examination, and MRI or CT imaging techniques. Pain Most patients who present with sciatica due to lumbar disc herniation respond to conservative and rest treatments, but patients who do not respond to medical treatment and rest undergo lumbar MRI imaging without contrast and if indicated Clinically, the presence of a disc herniation undergoes surgery with a pressure effect on the spinal sac or nerve root. Clinical indication for lumbar disc herniation surgery occurs when, despite rest, the pain persists for more than 4 weeks, due to high pressure, the person develops paresthesia in the lower extremities, the patient's pain recurs frequently and the patient's life Disrupt. Chronic diseases such as back pain have important consequences, including changes in people's quality of life. Quality of life is a multidimensional structure that is characterized by social, mental and physical vitality and causes a feeling of vitality and satisfaction with life, and certainly spinal surgery affects the quality of life in all dimensions. In the present study, the quality of patients' health before and after lumbar disc herniation surgery and the necessity of disc surgery were investigated.

In this descriptive-analytical study in which samples were selected by convenience, 90 patients with chronic low back pain who were candidates for lumbar disc herniation surgery were studied. Data were collected through the 36-SF Health Quality Questionnaire and also using a demographic questionnaire, patient demographic information including age, sex, height, weight, smoking, occupation and level of education was collected. Before the operation, the 36-SF questionnaire was used to assess the quality of patients' health. After the operation, patients were followed up in two stages of 6 months and then 12 months with the help of the questionnaire and their quality of life was re-evaluated. Exclusion criteria included patients who had complications from surgery during the follow-up period, including wound infection, nerve root damage and neurological defects, incomplete recovery of lower back and lower extremity pain, and recurrence of disc herniation. They were lumbar or found a new history of other diseases such as stroke, rheumatoid arthritis, autoimmune disease, in which case they were excluded from the study. Descriptive statistics including calculation of numerical indices (mean and standard deviation) for quantitative traits and percentage for qualitative traits were used for summarization. Also, paired t-test was used to analyze quantitative data and Wilcoxon test was used if necessary and KS test was used for data normality. The stratification method was used for comparative purposes in terms of contextual variables. Then the samples were analyzed with SPSS-20 software.

Mean and standard deviation of score improvement in physical dimension of quality of life before and 6 months after treatment in terms of sex were 38.60 9 9.13 in men and 31.90 56 8.56 in women, which was statistically different. Was significant (p = 0.005). Also, the mean and standard deviation of the score improvement in physical dimension of quality of life before and 12 months after treatment was 43.58 6 6.72 in men and 40.37 24 7.24 in women, which was not statistically significant (p=0.009). The mean and standard deviation of the score improvement in the psychological dimension of quality of life before and 6 months after treatment was 18.41 ± 11.72 in men and 14.26 37 7.37 in women, which was statistically significant (p<0.001)), also the mean and standard deviation of the score improvement in the psychological dimension of quality of life before and 12 months after treatment was estimated to be 24.93 9 9.69 in men and 29.26 86 8.86 in women, which was statistically significant. In women, there was more improvement than men. Mean and standard deviation of score improvement in physical dimension Quality of life before and 6 months after treatment in patients based on the duration of low back and lower limb pain, in two groups under 2 months and above 2 months were studied. The results showed that in the group under 2 months, 39.06 18 7.18 in the group above 2 months was 32.59 36 9.36 which was statistically significant (p=0.012) so that Patients with less back and lower limb pain (less than 2 months) showed more improvement. Also, the mean and standard deviation of the score improvement in the physical dimension of quality of life before and 12 months after treatment in the group under 2 months was 45.37 86 7.86 in the group over 2 months was 38.68 10 10.31, which was different from Statistically significant (p=0.08) that patients with less back and lower extremity pain (less than 2 months) showed more improvement. In general, the mean score of physical and mental health improvement was significantly different from Paying attention to body mass index, number of involved discs and smoking before, 6 and 12 months later showed that according to the results of independent t-test, the score of improving the quality of life in physical and mental dimensions; Compared to before, 6 months and 12 months after surgery were statistically significant among men and women and showed an increase in quality of life in both physical and psychological dimensions (p<0.001).

The results of the present study showed that the quality of life in the present study in the time periods before treatment, 6 and 12 months after treatment caused a significant improvement in the physical and mental condition of patients with lumbar disc herniation so that the mean score of quality of life Before the intervention, it was increased to 5.94 29 29.5, 6 months after the intervention to 60.17 4 4.55 and in 12 months after the intervention to 65.26 6 6.18, which statistical test also showed a significant increase (p<0.001).

Computed tomography (CT) scan is a valuable tool for diagnosis of abnormalities in brain or spinal cord as it has a high resolution in these tissues. Considering the importance of this subject, the researchers have aimed to evaluate the frequency of unnecessary CT scans performed for trauma patients in order to prevent unnecessary use of this diagnostic modality to avoid imposing probable side effects and financial burden on both the patient and the hospital.

In this cross-sectional study, through simple random sampling, participants were selected from fully conscious (Glasgow Coma Scale (GCS)=15) patients who presented to the emergency department with head trauma and underwent brain CT scan. The reasons for ordering a brain CT scan were recorded through an interview with the in-charge physician at the time of ordering this procedure, and clinical signs and demographic characteristics of the patients were also recorded using a questionnaire.

121 (81.8%) of the patients had normal CT scan, and skull fracture and hematoma were the most frequent complications found after trauma. The results also showed that in 90 (60.8%) cases, CT scan was ordered for documentation and legal purposes, and for 22 (14.9%) cases it was ordered because the patient had insisted and it was not deemed necessary by the in-charge physician, and only 26 (17.6%) were requested by the senior physician, which indicates that CT scans are not always necessary.

According to the results of this study, 18.2% of the CT scans performed on patients with mild head trauma showed at least 1 pathologic finding. Skull fracture and formation of intracranial hematoma were the most common pathologic findings in the CT scans of patients following mild head trauma. Due to the high frequency of normal CT scan results, in order to reduce the amount of radiation in patients and decrease the number of unnecessary CT scans, it is suggested to plan more strict criteria for ordering CT scans.

Traumatic brain injury is one of the most common causes of death among 1-45 year-old people. The aim of this study was to determine the relationship between CT scan findings of brain and consciousness level، surgical findings and outcome of the patients with traumatic intracranial hemorrhage. This study was a descriptive-analytical study which was conducted on 41 patients with visible and measurable traumatic intracranial hematoma detected by CT scan who referred to Taleghani hospital in Kermanshah. The patients’ consciousness level was measured and recorded by GCS (Glasco Coma Score) on admission and in intervals of 6 and 24 hours after operation. Data were analyzed by statistical tests run bySPSS software (version 20). Based on the CT scan findings، the hematoma location in 18 patients (43. 9%) was epidural، in 11 (26. 8%) patients was subdural and in 12 (29. 3 %) patients was intraparenchymal. Loss of consciousness on admission in 48. 4% of patients was mild in degree، in 29% of patients was moderate and in 22. 6% of patients was severe. In the operated patients، there was a significant correlation between the patients’ outcome and consciousness level on admission، before surgery، 24 hours after surgery and on discharge time. Also، there was a significant correlation between the outcome of non-operated patients and consciousness level on discharge. The results of this study indicate that the outcome of the patients with brain injury was dependent on the consciousness level and there was a reverse correlation between hematoma volume and amount of midline shift in CT scan.

Low back pain is the most common symptom that requires medical care and causes musculoskeletal morbidity and many social and economic inconveniences. Epidural steroid injection for low back pain is a common treatment. Due to the ease of the technique and less complications for caudal epidural steroid injection this study compares the relative effectiveness of caudal versus standard lumbar procedure. In this randomized، double-blind clinical trial of 68 patients aged 60-20 years with Class 1 and 2 ASA radicular back pain symptoms were divided into two groups based on assessment of pain on a visual Analog Score (VAS). Oswestry disability index (ODI) and general questions SF-36 was completed. The lumbar region in control group and the sacral hiatus in the study group were selected for injection. The results were analyzed. P<0. 05 was considered significant. In both groups there was a significant difference according to VAS before and one week and one month after injection. Similar results were obtained in two groups based on the Oswestry disability index questionnaire. Finally، both in the treatment group relative measure of progress wasachieved with regard to the physical part of SF-36 questionnaire، but there was no significant difference between the two groups at the same time (p> 0. 05). Both injection methods can improve the quality of life and reduce the severity of pain anddisability in patients and there was no significant difference between the injection methods and anyone can be used depending on the situation.

The external genital traumas may lead to emotional and physical complications which can be prevented in case of knowing the types and common creating causes. This study was carried out to determine the frequency of external genital trauma in patients who were admitted to Motazedi hospital at Kermanshah University of Medical Sciences in 1376-1382. This descriptive study was carried out by available data. The data was collected by information form that contained some variables such as patient’s age, job, menarche situation, season, cause of trauma and related complications. The records of all of the patients who were admitted to Motazedy hospital in 1376-1382 were studied. The collected data was analyzed by descriptive statistics. The study on 82 patients showed that 30.5% were students, 68.3% housewives, 64.4% lived in cities, the maximum frequency of genital trauma in summer and spring were30.5% and 24.4% respectively. The most common trauma was due to first coitus (47.6%) and the damage was most often located at the vulvovaginal (67.1%) as well as urethra (31.1%). This study showed the most common cause of genital trauma is due to first coitus, thus it is recommended to plan a well educational program to increase knowledge and prepare young person before getting married.